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目的横贯性脊髓炎(transversemyelitis,TM)是系统性红斑狼疮(systemiclupuserythe-matosus,SLE)少见的严重合并症。本文报道8例并结合文献复习,对其临床表现、治疗方法、预后进行分析。方法回顾了本院1998—2005年的住院和门诊随访病例,报道8例SLE合并TM,并文献复习。结果8例(7例女性,1例男性)SLE发病年龄中位数为19岁(15￣32岁),SLE距TM发病的中位数时间为8个月(0￣12年),就诊时间距TM发病的中位数为3.3个月(0￣7年)。脊髓病变1例发生在颈髓,余7例均定位在胸髓(T1￣T9)。脊髓磁共振成像(MRI)有助于诊断,其中3/7例呈T2加权长条形病变,4/7例呈斑点状病变。其他临床表现、血清学(其中2例存在抗磷脂抗体)、脑脊液均无特征性提示。4/8例遗留明显的神经系统后遗症。其中3例进行了地塞米松鞘内注射治疗,仅1例有短暂疗效。另外4例完全恢复或基本恢复,其中3例在TM发生早期(<10d)接受了大剂量激素治疗,1例有自愈倾向。结论TM是SLE少见的严重合并症,倾向于早年、早期出现,多累及胸髓。早期积极治疗可能改善预后,肌力Ⅲ级以上者预后较好。
Purpose transverse myelitis (TM) is a rare severe complication of systemic lupus erythematosus (SLE). This article reports 8 cases combined with literature review, its clinical manifestations, treatment methods, prognosis analysis. Methods The hospital and outpatient follow-up cases from 1998 to 2005 in our hospital were reviewed. Eight cases of SLE combined with TM were reviewed and reviewed. Results The median age at onset of SLE in 8 cases (7 women and 1 male) was 19 years (15-32 years). The median time to SLE onset from TM was 8 months (range, 0-12 years) The median incidence of TM was 3.3 months (0-7 years). One case of myelopathy occurred in the cervical cord, and the other seven cases were located in the thoracic cavity (T1 ~ T9). Spinal cord magnetic resonance imaging (MRI) is helpful in the diagnosis, of which 3/7 cases were T2-weighted strip-shaped lesions and 4/7 cases were spot-like lesions. Other clinical manifestations, serology (2 cases of anti-phospholipid antibodies), cerebrospinal fluid no characteristic tips. 4/8 left behind obvious neurological sequelae. Three of them were treated with dexamethasone intrathecal injection, and only one patient had a transient effect. The other 4 cases recovered completely or recovered basically. Three of them received high-dose hormone therapy in the early stage of TM (<10 days), and one case had self-healing tendency. Conclusions TM is a rare severe complication of SLE, which tends to appear in early years, early stage and multiple chest radiographs. Early active treatment may improve the prognosis, grade III or more good prognosis.