全身性紅斑性狼瘡合併脊髓病變－－兩例報告與文獻回顧

Spinal Cord Involvement in Systemic Lupus Erythematosus: A Report of Two Cases and Review of the Literature

兩位長期罹患全身性紅斑性狼瘡症的年輕女性患者，於病程中發生脊髓病變。第一例為典型之突發性下身麻痺，但由神經學檢查可進一步證實其中樞神經系可能有多處病灶存在。這種多發性病變可能與常見於紅斑性狼瘡症之瀰漫性血管炎有關，但某些與紅斑性狼瘡症關係仍未明白之髓鞘脫失性疾病也須考慮。第二例除了出現典型之脊髓病變之外，尚有頭痛、頸僵直及全身痙攣等症狀，腦波圖則有瀰漫性之腦皮質機能障礙。這些臨床表現顯示發生了一種更廣泛，包括腦膜、腦質及脊髓在內之中樞神經合併症。兩例吾人皆投以Prednisolone，每天60毫克口服，其狼瘡症之活性皆可獲得控制，然脊髓病變於治療期間都無改善。全身性紅斑性狼瘡症合併脊髓病變，第一例乃由Fisher於1939年發表。迄今45年來仍只有42例左右見諸於文獻。故對於此種罕見併發症之了解仍有待累積更多之經驗。吾人回顧文獻之記載，並將本文之兩例報告與之做對照與討論。

Two patients with a long- standing history of systemic lupus erythematosus (SLE) developed characteristic features of transverse myelitis. One case developed sudden onset of paraplegia involving C6 and T10, and possibly the brainstem or cerebellum. Another had slowly progressing myelopathy with evident involvement of the brain and meninges. Therapy with prednisolone, 60 mg daily, controlled the SLE activity in both patients but the neurological deficit remained the same. A thorough review of the literature is made to correlate the clinical features of the two patients reported.