系统性红斑狼疮、抗磷脂抗体综合征伴颅内静脉窦血栓形成1例并文献复习

doi:10.6040/j.issn.1671-7554.0.2021.1457

摘要/Abstract

摘要： 目的探讨系统性红斑狼疮(SLE)及抗磷脂抗体综合征(APS)并发颅内静脉窦血栓形成(CVST)的临床表现、诊断及治疗方法。方法分析1例SLE、APS合并CVST患者的病例资料,并进行文献复习。结果该病例为32岁青年女性,以头痛、发热为主要临床表现,颅脑MRV考虑CVST,SLE、APS相关抗体阳性,该患者病程中先后经历多种类型发热,经抗感染、抗凝、降颅压、预防癫痫、激素治疗原发病后病情好转。结论 SLE、APS合并CVST较为罕见,因其临床症状不典型,易发生漏诊,临床上对不明原因出现头痛、癫痫发作、局灶性脑损害的患者应尽早完善颅脑MRI/MRV检查及风湿系列抗体筛查。

关键词: 系统性红斑狼疮, 抗磷脂抗体综合征, 颅内静脉窦血栓形成, 发热, 头痛

Abstract: Objective To investigate the clinical manifestations, diagnosis and treatment of systemic lupus erythematosus(SLE)and antiphospholipid syndrome(APS)complicated with cerebral venous sinus thrombosis(CVST). Methods The clinical data of the patient were analyzed, and relevant literature was reviewed. Results The patient was a 32-year-old woman with headache and fever as the main clinical manifestations. Brain MRV indicated CVST. Antibodies related to SLE and APS were positive. The patient successively experienced fever with different origins during the course of the disease. Her condition was improved after anti-infection, anticoagulation, intracranial pressure reduction, epilepsy prevention, and hormone therapy for the primary disease. Conclusion SLE and APS complicated with CVST are rare. Due to the atypical clinical symptoms, missed diagnosis is easy to occur. Brain MRI/MRV and antibody screening should be performed as soon as possible in patients with unexplained headache, seizures and local brain damage.

Key words: Systemic lupus erythematosus, Antiphospholipid syndrome, Cerebral venous sinus thrombosis, Fever, Headache

中图分类号:

R593.2

成晅,杨帆,潘正论. 系统性红斑狼疮、抗磷脂抗体综合征伴颅内静脉窦血栓形成1例并文献复习[J]. 山东大学学报 (医学版), 2022, 60(6): 70-74.

CHENG Xuan, YANG Fan, PAN Zhenglun. Systemic lupus erythematosus, antiphospholipid syndrome with cerebral venous sinus thrombosis: a case report and literature review[J]. Journal of Shandong University (Health Sciences), 2022, 60(6): 70-74.

参考文献

[1] Tsang ASMWP, Bultink IEM. New developments in systemic lupus erythematosus [J]. Rheumatology(Oxford), 2021, 60(Supplement_6): 21-28.
[2] Arnaud L, Tektonidou MG. Long-term outcomes in systemic lupus erythematosus: trends over time and major contributors [J]. Rheumatology(Oxford), 2020, 59(Supplement_5): 29-38.
[3] Zhang BZ, Lang Y, Zhang W, et al. Characteristics and management of autoimmune disease-associated cerebral venous sinus thrombosis [J]. Front Immunol, 2021, 12: 671101. doi:10.3389/fimmu.2021.671101.
[4] Wang L, Chen H, Zhang Y, et al. Clinical characteristics of cerebral venous sinus thrombosis in patients with systemic lupus erythematosus: a single-centre experience in China [J]. J Immunol Res, 2015, 2015: 540738. doi:10.1155/2015/540738.
[5] Luo YX, Tian X, Wang XF. Diagnosis and treatment of cerebral venous thrombosis: a review [J]. Front Aging Neurosci, 2018, 10: 2. doi:10.3389/fnagi.2018.00002.
[6] Capecchi M, Abbattista M, Martinelli I. Cerebral venous sinus thrombosis[J]. J Thromb Haemost, 2018, 16(10): 1918-1931.
[7] Gazioglu S, Dinc G. Cerebral venous sinus thrombosis in pregnancy and puerperium [J]. Acta Neurol Belg, 2021, 121(4): 967-972.
[8] Singh RK, Bhoi SK, Kalita J, et al. Cerebral venous sinus thrombosis presenting feature of systemic lupus erythematosus [J]. J Stroke Cerebrovasc Dis, 2017, 26(3): 518-522.
[9] Uthman I, Noureldine MHA, Ruiz-Irastorza G, et al. Management of antiphospholipid syndrome [J]. Ann Rheum Dis, 2019, 78(2): 155-161.
[10] Shaban A, Leira EC. Neurological complications in patients with systemic lupus erythematosus [J]. Curr Neurol Neurosci Rep, 2019, 19(12): 97.
[11] Chaturvedi S, Braunstein EM, Yuan X, et al. Complement activity and complement regulatory gene mutations are associated with thrombosis in APS and CAPS [J]. Blood, 2020, 135(4): 239-251.
[12] Shen HX, Huang XQ, Fan CQ. Clinical characteristics and management of cerebral venous sinus thrombosis in patients with antiphospholipid syndrome: a single-center retrospective study [J]. Clin Appl Thromb off J Int Acad Clin Appl Thromb, 2021, 27: 1076029621999104. doi:10.1177/1076029621999104.
[13] Aringer M, Costenbader K, Daikh D, et al. 2019 European League Against Rheumatism/American College of Rheumatology classification criteria for systemic lupus erythematosus[J]. Ann Rheum Dis, 2019, 78(9):1151-1159.
[14] Miyakis S, Lockshin MD, Atsumi T, et al. International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome(APS)[J]. J Thromb Haemost, 2006, 4(2): 295-306.
[15] 林志航, 明德松, 郭如意. 213株草绿色链球菌的分布和耐药性分析[J]. 中国抗生素杂志, 2017, 42(11): 989-992. LIN Zhihang, MING Desong, GUO Ruyi. Distribution and antibiotic resistance of 213 strains of Viridans Streptococcus [J]. Chinese Journal of Antibiotics, 2017, 42(11): 989-992.
[16] Deutschmann MW, Livingstone D, Cho JJ, et al. The significance of Streptococcus anginosus group in intracranial complications of pediatric rhinosinusitis [J]. JAMA Otolaryngol Head Neck Surg, 2013, 139(2): 157-160.
[17] 佟玲, 孙蜀宁. 咽峡炎链球菌感染的脑膜炎1例[J]. 大连医科大学学报, 2018, 40(6): 575-576.
[18] 李莉, 杨琴, 陈杰华, 等. 咽峡炎链球菌致儿童脓肿性疾病8例临床分析[J]. 中国感染与化疗杂志, 2021, 21(2): 185-188. LI Li, YANG Qin, CHEN Jiehua, et al. Clinical analysis of the abscesses caused by Streptococcus anginosus in children [J]. Chinese Journal of Infection and Chemotherapy, 2021, 21(2): 185-188.
[19] Fan Y, Yu J, Chen H, et al. Chinese Stroke Association guidelines for clinical management of cerebrovascular disorders: executive summary and 2019 update of clinical management of cerebral venous sinus thrombosis [J]. Stroke Vasc Neurol, 2020, 5(2): 152-158.
[20] Sara IP, Dhineshreddy G, Manikandan P, et al. Cerebral venous thrombosis: a comprehensive review [J]. Eur Neurol, 2020, 83(4): 369-379.
[21] Duman T, Demirci S, Uluduz D, et al. Cerebral venous sinus thrombosis as a rare complication of systemic lupus erythematosus: subgroup analysis of the VENOST study [J]. J Stroke Cerebrovasc Dis, 2019, 28(12): 104372. doi: 10.1016/j.jstrokecerebrovasdis.2019.104372.
[22] Ghoneim A, Straiton J, Pollard C, et al. Imaging of cerebral venous thrombosis [J]. Clin Radiol, 2020, 75(4): 254-264.
[23] Gao LS, Xu WL, Li T, et al. Accuracy of magnetic resonance venography in diagnosing cerebral venous sinus thrombosis [J]. Thromb Res, 2018, 167: 64-73. doi: 10.1016/j.thromres.2018.05.012.
[24] 中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国颅内静脉血栓形成诊断和治疗指南2019[J]. 中华神经科杂志, 2020, 53(9): 648-663. Chinese guidelines for diagnosis and treatment of cerebral venous thrombosis 2019 [J]. Chinese Journal of Neurology, 2020, 53(9): 648-663.
[25] Ferro JM, Bousser MG, Canhão P, et al. European Stroke Organization guideline for the diagnosis and treatment of cerebral venous thrombosis-endorsed by the European Academy of Neurology [J]. Eur J Neurol, 2017, 24(10): 1203-1213.

相关文章 15

[1]	康随芳,王迎雪,张琪晨,王志仑,尹哲,肖娟,陈国玲. 系统性红斑狼疮患者睑板腺形态和功能的异常及其对泪膜的影响[J]. 山东大学学报 (医学版), 2024, 62(6): 65-70.
[2]	张新蕊,孙鹏,李峰. 基于增长混合模型的脑肿瘤患者开颅术后头痛发展轨迹分析[J]. 山东大学学报 (医学版), 2024, 62(6): 102-107.
[3]	韩璐怿,田雪莹,高琦,佘凯丽,曹云贤,魏淑淑,丁淑军,李秀君. 基于MaxEnt的山东省SFTS影响因素评估及风险区域预测[J]. 山东大学学报 (医学版), 2023, 61(4): 103-110.
[4]	徐洪波,胡仁琴,田茂强,冉潇,陈艳. PIK3CD基因杂合突变所致新表型——系统性红斑狼疮[J]. 山东大学学报 (医学版), 2023, 61(1): 113-117.
[5]	孔林笑语,孙书珍,余丽春,贾梦文. 188例儿童系统性红斑狼疮5年生存率及预后分析[J]. 山东大学学报 (医学版), 2022, 60(12): 69-76.
[6]	国云飞,舒强. 免疫抑制剂在风湿病相关复发性流产中的应用[J]. 山东大学学报 (医学版), 2021, 59(8): 38-43.
[7]	师少乐,宫伟雁. 妊娠相关噬血细胞性淋巴组织细胞增多症1例[J]. 山东大学学报 (医学版), 2020, 58(6): 121-124.
[8]	李海云,乔珊,崔才三. 127例颅内静脉窦血栓形成的回顾性分析[J]. 山东大学学报 (医学版), 2020, 58(5): 77-81.
[9]	王百惠,宋艳君,张帅庆,左秀丽,王青,张爱军,李如源. 以腹泻为首发症状的淀粉样变3例及文献复习[J]. 山东大学学报 (医学版), 2020, 58(5): 93-97.
[10]	王旭,张丹丹,郑兆磊,王珮竹,许勤勤,王显军,丁淑军,李秀君. 威海市发热伴血小板减少综合征与气象因素关系[J]. 山东大学学报 (医学版), 2018, 56(8): 114-120.
[11]	冯洒然,刘倩,王焱,李红,毕可红,朱传升. 系统性红斑狼疮伴发肝脾γδT细胞淋巴瘤1例并文献复习[J]. 山东大学学报 (医学版), 2018, 56(6): 87-90.
[12]	张好. 系统性红斑狼疮合并狼疮脑病、重症自身免疫性胰腺炎1例[J]. 山东大学学报 (医学版), 2018, 56(2): 93-94.
[13]	曲晓霞. 有汗性外胚叶发育不良合并系统性红斑狼疮1例[J]. 山东大学学报 (医学版), 2018, 56(2): 95-96.
[14]	孙鲁艳,张秀珍,刘葵花,杨铂,吴谙诏,袁成民. 山东省2014—2015年74例发热伴血小板减少综合征流行病学及临床特征[J]. 山东大学学报 (医学版), 2018, 56(12): 98-102.
[15]	杜金阁,陈慧,杨孝荣,吕明. STAT4 rs7574865位点单核苷酸多态性与系统性红斑狼疮易感性Meta分析[J]. 山东大学学报（医学版）, 2017, 55(5): 95-102.

多维度评价

Viewed

Full text

Abstract

Cited

Shared

Discussed