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目的探讨系统性红斑狼疮(SLE)合并中枢神经系统结核感染(CNS-TBI)的临床特点、实验室检查和治疗转归等特点。方法回顾分析了我院1979年6月至2009年6月完整的11例SLE患者合并CNS-TBI的病例资料,进行回顾性分析,对临床表现进行鉴别分类,对实验室检查、治疗、转归进行分析。结果 11例患者女10例、男1例,年龄中位数36岁。合并CNS-TBI时SLE的病程中位数为41个月,SLE疾病活动指数(SLEDAI)评分中位数9分。2例患者接受了大剂量激素治疗(18.2%),4例患者接受了冲击剂量激素治疗(36.4%)。结核分枝杆菌的病原学检查(脑脊液涂片或培养)阳性者仅有4例(4/9,44.4%)。11例患者中6例在中枢结核感染的同时合并肺结核,4例为血行播散型肺结核,2例为浸润型肺结核。预后较差,有6例死亡,死亡率高达54.5%。结论 SLE合并CNS-TBI临床表现复杂,预后差。结核分枝杆菌病原学检查阳性率低,T细胞酶联免疫检测(T-SPOT.TB)有协助鉴别诊断意义,需在充分治疗SLE基础上积极抗结核治疗。
Objective To investigate the clinical features, laboratory tests and treatment outcome of systemic lupus erythematosus (SLE) complicated with central nervous system tuberculosis infection (CNS-TBI). Methods The data of 11 cases with SLE complicated with CNS-TBI in our hospital from June 1979 to June 2009 were retrospectively analyzed. The clinical manifestations were classified and classified, and the laboratory tests, treatment and outcome were retrospectively analyzed Analyze. Results 11 patients were female and 10 patients, 1 male, median age 36 years. The median duration of SLE with CNS-TBI was 41 months and the median SLE Disease Activity Index (SLEDAI) score was 9 points. Two patients received high-dose hormone therapy (18.2%) and four received shock-dose hormone therapy (36.4%). Mycobacterium tuberculosis etiological examination (cerebrospinal fluid smear or culture) positive only 4 cases (4 / 9,44.4%). Six of the 11 patients had tuberculosis concurrent with CNS infection, four were hematogenous disseminated tuberculosis and two were infiltrating pulmonary tuberculosis. The prognosis is poor, with 6 deaths and a mortality rate of 54.5%. Conclusions The clinical manifestations of SLE combined with CNS-TBI are complex and the prognosis is poor. The positive rate of Mycobacterium tuberculosis etiological examination is low. T-SPOT.TB is helpful in differential diagnosis, and should be actively treated with anti-tuberculosis on the basis of sufficient treatment of SLE.