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目的 总结系统性红斑狼疮 (SLE)并发狼疮脑病CNS SLE时的临床特点及误诊原因。方法 回顾性分析我院确诊的 61例CNS SLE的临床资料 ,并随机抽取同期住院确诊的 60例病毒性脑炎作对照。结果 CNS SLE误诊率为 91 8% ,误诊疾病有中枢神经系统感染、脑梗死、原发性癫、精神分裂症、脊髓炎等。与对照组相比 ,CNS SLE组年青女性多见 ,脑脊液异常及头颅影像学 (CT/MRI)阳性率高于对照组 (P <0 0 1) ,CNS SLE确诊后 ,应用甲基强的松龙或联合环磷酰胺冲击治疗的有效率75 % ,明显高于确诊前治疗的有效率 (16% ) (P <0 0 1)。结论 CNS SLE易误诊为各种脑病及精神障碍 ,临床若有年青女性 ,伴有多系统损害 ,有脑病症状者 ,应重视实验室及脑脊液检查 ,及早行免疫学检验确诊 ,并及时治疗。
Objective To summarize the clinical features and misdiagnosis of systemic lupus erythematosus (SLE) complicated with lupus encephalopathy CNS SLE. Methods The clinical data of 61 cases of CNS SLE diagnosed in our hospital were retrospectively analyzed. Sixty cases of viral encephalitis diagnosed at the same period were randomly selected as controls. Results The misdiagnosis rate of CNS SLE was 91.8%. The misdiagnosed diseases were central nervous system infection, cerebral infarction, primary epilepsy, schizophrenia and myelitis. Compared with the control group, young women in the CNS SLE group were more common, and cerebrospinal fluid abnormalities and CT / MRI positive rates were higher than those in the control group (P <0.01). After CNS SLE was diagnosed, prednisone Dragon or combination of cyclophosphamide impact treatment of 75% efficiency was significantly higher than the effective rate of pre-diagnosis (16%) (P <0.01). Conclusions CNS SLE is easily misdiagnosed as various encephalopathy and mental disorders. If there are young women in clinic, with multiple system damage and symptoms of encephalopathy, CNS SLE should pay attention to laboratory and cerebrospinal fluid examination and be diagnosed as early as possible by immunological tests and treated promptly.