摘要目的 总结系统性红斑狼疮(SLE)合并中枢神经系统(CNS)结核瘤的临床特点,提高临床医师对此病的认识.方法 回顾分析2009年至2011年北京协和医院收治的8例SLE合并CNS结核瘤患者临床资料,总结其临床特点、治疗和转归.结果 SLE合并CNS结核瘤的发生率约0.45％(8/1768).8例SLE患者出现CNS结核瘤的平均病程为(39 ±32)个月,泼尼松维持用量均＞15 mg/d.SLE患者诊断CNS结核瘤时7例(7/8)患者SLEDAI评分小于5分.CNS结核瘤的常见症状包括发热(7/8)、头痛(5/8)、运动或感觉障碍(5/8)等,1例出现一过性全身抽搐伴意识丧失.脑脊液检查主要表现为压力升高和蛋白水平升高(分别为5/8),仅1例患者白细胞数显著升高,多正常或轻度升高.CNS结核瘤在MRI增强扫描中特征性表现为异常类圆形信号并环形强化,可分布于颅内或者脊髓.8例患者均伴有其他部位结核,包括肺、消化道和皮肤.所有患者均予抗结核治疗,1例患者同时接受手术.随访7例患者平均(20±9)个月,仅3例遗留轻微症状,治疗均有效(7/7).结论 SLE合并CNS结核瘤常发生于长期激素治疗患者,多数SLE病情稳定,其临床表现和脑脊液改变不典型,伴发全身多部位结核感染灶可协助诊断,头颅或脊髓MRI增强扫描可见特征性类圆形信号并环形强化.SLE合并CNS结核瘤经早期积极诊治,预后良好.

abstractsObjective To review the clinical features of systemic lupus erythematosus (SLE) patients with central nervous system (CNS) tuberculoma.Methods The medical records of 8 SLE patients with CNS tuberculoma,who were admitted to Peking Union Medical College Hospital from January 2009 to January 2012,were reviewed in this retrospective study.Results CNS tuberculoma occurred averagely 39 months after immunosuppressive therapy with an incidence of 0.45％ in SLE patients.These patients had an average SLEDAI score less than 5,and their minimal maintenance dose of prednisone was 15 mg/d.Fever (7/8),headache (5/8),motion and sensory disorder (5/8) were the most common symptoms of CNS tuberculoma in SLE patients,and one patient had temporary seizure with loss of consciousness.Cerebrospinal fluid pressure and protein level of these patients increased significantly,while white blood cells were mostly normal or mildly elevated.Gadolinium-enhanced MRI revealed specific ring-like masses in all cases.Other organs infected with tuberculosis occurred in all of them.They all received anti-tuberculosis drugs and one had additional cerebral operation.Seven patients were followed for (20 ± 9) months and all recovered.Conclusions CNS tuberculoma usually occurred in non-active SLE patients receiving long-term immunosuppressive therapy,with atypical clinical manifestations and cerebrospinal fluid changes.Enhanced MRI showed ring-like masses which were specific for diagnosis of CNS tuberculoma.Early diagnosis and effective anti-tuberculosis therapy contributes to a benign prognosis.