摘要：

目的: 探讨神经精神狼疮患者神经功能改变及其与认知功能和情绪的相关性。方法: 纳入2020年6月至2022年9月南京医科大学附属泰州人民医院收治的46例系统性红斑狼疮患者，根据是否具有神经精神症状分为神经精神狼疮组（NPSLE组，26例）和非神经精神狼疮组（非NPSLE组，20例），采用静息态fMRI计算平均局部一致性（mReHo）和平均分数低频振幅（mfALFF），简易智能状态检查量表（MMSE）评价整体认知功能，运动和认知功能疲劳量表（FSMC）评价运动和认知疲劳，医院焦虑抑郁量表（HADS）评价焦虑和抑郁情绪；Pearson相关分析和偏相关分析探讨神经精神狼疮患者脑局部mReHo值和mfALFF值与神经心理学测验评分之间的相关性。结果: NPSLE组MMSE评分（Z=-3.934，P=0.000）低于非NPSLE组，FSMC-运动（t=2.016，P=0.050）和认知（t=2.055，P=0.046）、HADS-焦虑（Z=-2.424，P=0.015）和抑郁（Z=-2.731，P=0.006）评分高于非NPSLE组。神经精神狼疮患者右侧背外侧额上回、右侧枕中回、右侧中央后回、右侧顶下缘角回、右侧颞下回mReHo值降低，右侧枕中回、右侧中央后回mfALFF降低（FDR校正；体素水平P < 0.001，团块水平P < 0.05）。相关分析显示，神经精神狼疮患者右侧中央后回mReHo值（r=-0.483，P=0.017）和mfALFF值（r=-0.504，P=0.012）与HADS-抑郁评分呈负相关；右侧顶下缘角回mReHo值与FSMC-运动（r=-0.475，P=0.019）和认知（r=-0.414，P=0.044）评分呈负相关；右侧颞下回mReHo值与FSMC-认知评分呈负相关（r=-0.427，P=0.037）。结论: 神经精神狼疮患者存在脑局部自发神经元活动异常，且神经功能与神经心理学测验评分密切相关。

关键词: 狼疮血管炎，中枢神经系统, 磁共振成像, 神经心理学测验

Abstract:

Objective: To investigate the changes of neural function and its correlation with cognitive function and emotion in patients with neuropsychiatric systemic lupus erythematosus (NPSLE). Methods: A total of 46 patients with systemic lupus erythematosus (SLE) admitted to The Affiliated Taizhou People's Hospital of Nanjing Medical University from June 2020 to September 2022 were included. The patients were divided into the NPSLE group (n=26) and the non-NPSLE group (n=20) based on the presenceor absence of neuropsychiatric symptoms. The mean regional homogeneity (mReHo) and mean fractional amplitude of low-frequency fluctuation (mfALFF) were calculated by resting-state fMRI (rs-fMRI). The Mini-Mental State Examination (MMSE) was used to evaluate overall cognitive function, the Fatigue Scale for Motor and Cognitive Functions (FSMC) was used to assess both motor and cognitive fatigue, and the Hospital Anxiety and Depression Scale (HADS) was used to measure anxiety and depression mood. Pearson correlation analysis and partial correlation analysis were conducted to explore the correlation of mReHo and mfALFF values in various brain regions with neuropsychologcial tests. Results: The MMSE scores in NPSLE group was lower than non-NPSLE group (Z=-3.934, P=0.000). Additionally, the FSMC-Motor (t=2.016, P=0.050), FSMC-Cognition (t=2.055, P=0.046), HADS-Anxiety (Z=-2.424, P=0.015) and HADS-Depression (Z=-2.731, P=0.006) scores in NPSLE group were higher than those in non-NPSLE group. The mReHo values of the right dorsolateral superior frontal gyrus, right middle occipital gyrus, right posterior central gyrus, right inferior parietal margin angular gyrus and right inferior temporal gyrus decreased, while mfALFF values of the right middle occipital gyrus and right posterior central gyrus decreased in the NPSLE group (false discovery rate correction; voxel level P < 0.001, cluster P < 0.05). The mReHo and mfALFF in the right postcentral gyrus were both negatively correlated with HADS-Depression (r=-0.483, P=0.017; r=-0.504, P=0.012). The mReHo in the right inferior parietal gyrus was negatively correlated with FSMC-Motor (r=-0.475, P=0.019) and FSMC-Cognition (r=-0.414, P=0.044). The mReHo in the right inferior temporal gyrus was negatively correlated with FSMC-Cognition (r=-0.427, P=0.037). Conclusions: NPSLE patients exhibited abnormal local activity in brain regions, and neural function is closely related to neuropsychological test.

Key words: Lupus vasculitis, central nervous system, Magnetic resonance imaging, Neuropsychological tests