Posterior Reversible Encephalopathy Syndrome In Systemic Lupus Erythematosus

Objective: To analyse the clinical characteristics,treatment,and prognosis of posterior reversible encephalopathy syndrome(PRES)in systemic lupus erythematosus(SLE)patients,further investigate the pathogenesis and risk factors of SLE with PRES.Methods: 16 patients with SLE were sclected from the national clinical research center of kidney diseases in Jinling Hospital from September 2009 to March 2018.On admission,the age,sex,course of disease,systolic blood pressure(SBP),diastolic blood pressure(DBP),SLE-DAI,pathological diagnosis,clinical manifestation,treatment and prognosis were collected,urine white blood cells,urine red blood cells,urinary tube type,24-hour urinary protein quantification,blood white blood cell(WBC),platelet(PLT),lymph cell(LY),serum albumin(Alb),serum creatinine(Scr),urea nitrogen(BUN),triglyceride(TG),total cholesterol(TC),anti-double stranded DNA antibody(A-ds DNA),complement(C3,C4),anti-cardiolipin antibody profile,?2 glycoprotein I antibody,C1 q antibody,red cell debris were determined in all selected subjects.In addition,the head CT and MRI imaging date were collected.Statistical analysis was performed by SPSS 22.0 software,so that we investigated the pathogenesis,risk factors,treatment and prognosis of SLE with PRES.Result: 1.Of the 16 patients,14 were females and 2 were males,aged 9 to 43 years(mean(22.75±8.46)years).All 16 patients had severe lupus activity(13 patients who had no renal replacement therapy SLE-DAI score(20.92±4.44)).Most patients with SLE combined with PRES were young women with high lupus activity index.2.Of the 16 patients,15 cases with hypertension before the PRES hanppened,13 cases with renal insufficiency,low lymphocyte count,dyslipidemia at the same time,all 16 cases were treated with glucocorticoid,immunosuppressive agents or cytotoxic drugs,suggesting hypertension,low lymphocytes,dyslipidemia,glucocorticoid and other drugs may be the factors of PRES.3.Of the 16 patients,seizures in 16 cases,headache in 5 cases,visual disturbance in 5 cases,nausea and vomiting in 6 cases.The CT and magnetic resonance imaging(MRI)showed that the lesions were mostly located in the bilateral parieto-occipital lobe and could also affect the temporal lobe.,frontal lobe,ventricles,basal ganglia,cerebellum,and cortex,with hypotensive,antiepileptic,and low-dose glucocorticoid controlled lupus activity can relieve symptoms.Conclusion:SLE with PRES is a clinical-impaired syndrome,often associated with hypertension,renal insufficiency,severe lupus activity,lymphocyte hypolipidaemia,dyslipidemia,immunosuppressants and other drugs.If SLE with PRES can be diagnosed and treated in time,the lesions are generally reversible and mostly have a good prognosis.