神經精神性狼瘡患者血清學分析

Serum autoantibodies in neuropsychiatric systemic lupus erythematosus

目的：神經精神症狀在紅斑性狼瘡患者會導致類固醇需求劑量以及併發症增加並嚴重影響生活品質，而血清中自體抗體在紅斑性狼瘡患者神經精神症狀中所扮演的腳色目前仍沒有非常明確。方法：我們回顧性分析了2011年1月至2017年12月期間本院紅斑性狼瘡患者的病歷資料，神經精神臨床症狀包括癲癇發作，中風，思覺失調，情緒障礙，影像學上白質病變和失眠等。結果：狼瘡抗凝血試驗陽性在狼瘡患者增加神經精神症狀校正後勝算比為4.85，95%信賴區間為1.13至20.88，p值為0.034。狼瘡抗凝血試驗陽性對狼瘡患者產生神經精神症狀以接收者操作特徵曲線（ROC）分析，曲線下的面積（AUC）為0.601。血清抗核醣體P抗體陽性與白質病變雖沒達到統計上顯著的差異，但是在校正後勝算比為9.70×108。結論：紅斑性狼瘡患者血中抗磷脂抗體和抗核醣體P抗體只要呈現陽性反應不論濃度高低階有臨床症狀的預測價值，但是臨床醫師還是要以病人實際症狀以及理學檢查發現進行密切追蹤。

Objective:Neuropsychiatric events result in increased steroid doses, comorbidity, and decreased the quality of life in patients with systemic lupus erythematosus (SLE). It remains to be identified how serum autoantibodies contribute to the development and severity of neuropsychiatric SLE (NPSLE). Methods:We retrospectively analyzed data from patients with SLE at a single medical center between January 2011 and December 2017. Clinical manifestations, including seizure, stroke, psychosis, mood disorders, myelopathy, and insomnia, were accounted for the analysis. Results:There was an adjusted odds ratio (OR) of 4.85 with a 95% confidence interval of 1.13 to 20.88 of a positive lupus anticoagulant test leading to the development of NPSLE, with a p value of 0.034. The area under the receiver operating characteristic (ROC) curve was 0.601 for the contribution of a positive lupus anticoagulant test for the development of NPSLE. The presence of serum anti-Ribosomal P antibody revealed an adjusted OR of 9.70*108, though no statistically significant effect was observed on the development of myelopathy. Conclusions:The presence of antiphospholipid antibodies and anti-Ribosomal P antibody in SLE, regardless of the levels, shows predictive value for neuropsychiatric events. Direct statistical association was not achieved in this analysis; elucidation of the direct predictive value of autoantibodies for NPSLE events requires a larger study population.