The Clinical Features And Risk Factors Of Posterior Reversible Encephalopathy Syndrome In Systemic Lupus Erythematosus

Objective SLE is an autoimmune disease characterized by its protean clinical features and multi-system involvements,among which nervous system is the most common and one of the main causes of death.Over the past 50 years,NPSLE has been increasingly recognized and reported in the literature,and most NPSLE occurred at or within one year of the onset of SLE.Posterior reversible encephalopathy syndrome(PRES),also known as reversible posterior leukoencephalopathy syndrome(RPLS),is an uncommon clinical radiological symptom characterized by a rapid onset of headache,seizure,hypertension,visual impairment and cognitive changes,with brain neuroimaging including bilateral and asymmetrical vasogenic edema.Nearly half of PRES have a history of autoimmune diseases,of which SLE is the most common.One of the major manifestations of SLE is neuropsychiatric systemic lupus erythematosus(NPSLE),overlapped with the clinical features and course of PRES.The aim of this study is to describe the risk factors、clinical features、radiologic findings and treatment of Posterior reversible encephalopathy syndrome(PRES)in systemic lupus erythematosus(SLE).Methods 35 cases which both diagnosed with SLE and PRES,50 cases which diagnosed with NPSLE,9 case which diagnosed PRES but not conform to SLE were studied by a retrospective method.The differences of clinical features,laboratory indexes,the treatment and its prognosis were compared between groups.Student t test,chi-square test and multivariate Logistic regression were used for statistical analysis.A p<0.05 was considered statistically significant.ResultsA.There was no statistical significance in sex、the history of hypertension and the length of hospital stay between SLE/PRES and NPSLE groups.The younger was more common in SLE/PRES group.However,hypertension at the time of episodes and LN were more frequent in the SLE/PRES groups.B.The white blood count,neutrophil count,creatinine,urea nitrogen were all significantly higher in SLE/PRES group,however,the albumin and was the concentration of magnesium significantly lower in SLE/PRES group.C.The clinical features of seizures and visual impairment were more frequent in SLE/PRES group,but the clinical features of acute confusional state were more observed in NPSLE group.Comparing with the NPSLE group,lesions of the parieto-occipital,frontal and temporal lobes were more frequently in SLE/PRES group.D.As for the SLE/PRES group,different treatments had a significant difference in prognosis.The patients treated with high and low-dose glucocorticoid had a better prognosis than those with very high or pulse-dose glucocorticoid SLE/PRES.E.Multivariate Logistic regression analysis demonstrated that LN、hypertensive、the treatment with very high dose steroid 、 hypomagnesemia were independently associated with SLE/PRES.F.The creatinine,serum urea nitrogen,age,hypertensive at the time of PRES episode and were similar between SLE/PRES and PRESwo SLE groups.Comparing with the control group,the female were more common in SLE/PRES group.Conclusion We indicated that two novel risk factors of PRES are hypomagnesemia and very high dosages steroid,which can further explain its pathophysiology.Very high dosage glucocorticoid might be used prudently.The outcomes of PRES were not all reversible,so it is important to perform a diagnosis and treatment in SLE with PRES in time.