摘要目的 观察神经精神狼疮患者脑血流改变,探讨神经精神狼疮患者局部脑血流灌注(rCBF)显像的临床意义.方法 20例神经精神狼疮患者(NPSLE组)、20例无神经精神表现的狼疮患者(SLE组)和20名年龄相当的健康志愿者(健康组)行单光子发射计算机断层(SPECT)rCBF显像,并划取感兴趣区作半定量分析得半定量(HQ)值.比较各组SPECT rCBF显像结果,并对HQ结果进行分析.同时20例神经精神狼疮患者行CT/磁共振成像(MRI)显像并与rCBF显像进行对比.结果 NPSLE组患者rCBF显像均阳性100%,其中19例局部脑血流降低,1例局部脑血流增加;20例患者CT/MRI头部显像阳性4例(20%),同rCBF显像相比差异有统计学意义(P＜0.01).SLE组患者rCBF显像阳性1例(5%),表现为局部脑血流降低.20名健康志愿者rCBF显像未见异常.NPSLE组患者rCBF显像病灶主要分布在颞叶(36%)、额叶(18%).其颞叶、额叶HQ值与SLE对照组和健康对照组比较,差异有统计学意义(P＜0.01和P＜0.05). 结论 rCBF显像灵敏度高,对早期诊断和治疗神经精神狼疮有重要意义.神经精神狼疮患者rCBF显像多表现为局部脑血流降低,好发部位为大脑中动脉供血区,以颞叶、额叶多见.

abstractsObjecfive To observe the changes of regional cerebral blood flow (rCBF) in systemic lupus erythematosus (SLE) patients with neuropsychiatrie disorders and evaluate rCBF SPECT imaging in the detection of neuropsychiatric problems in SLE patients.Methods Twenty neuropsychiatrie SLE patients were enrolled in the study and were performed SPECT rCBF imaging anti CT/MRI scans,respectively.Twenty SLE patients without neuropsychiatrie manifestatiuns (SLE) and 20 healthy volunteers also underwent SPECT rCBF imaging as controls.Semiquantitative analysis was conducted as designed by selecting 3 consecutive crosssections and delineating ROI,which generated HQ and the results were compared between with SLE and controls.Results SPECT rCBF findings were almormal in 20 NPSLE.in which 19 of the 20 with abnormal SPECT findings showed focal uptake defects the other patient showed increased foeal uptake.Four N PSLE patients had ahnormal CT/MRI scans findings.Compared with the methods of rCBF and CT/MRI imaging,the difference was significant (P＜0.01).Nineteen SLE patients without neuropsychiatrie manifestations had normal SPECT findings.the other 1 patient showed focal uptake defect.SPECT findings were all normal in 20 healthy volunteers.Temporal cortex was the most commonly involved region,followed by frontal cortex.Specific values generated from semiquantitative analysis (HQ) of temporal and frontal regions in neruopsychiatrie SLE patients were lower than that in SLE patients and healthy volunteers (P＜0.01 and P＜0.05).Conclusion SPECT rCBF imaging has the potential to be a sensitive tool to detect the neuropsyehiatric disordersin SLE patients,and has important value in helping for early diagnosis and therapy.Hypoperfusion on ECD-SPECT under the territory of the middle cerebral artery (MCA) is the most common observation,and which temporal and frontal regions are the most frequently involved regions in neruopsychiatrie SLE patients.