rspНаучно-практическая ревматологияRheumatology Science and Practice1995-44841995-4492IMA-PRESS, LLC10.14412/1995-4484-2019-17-27rsp-2669Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL RESEARCHНейропсихические проявления в киргизской когорте больных системной красной волчанкойNeuropsychic manifestations in the Kyrgyz cohort of patients with systemic lupus erythematosusКойлубаеваГ. М.KoylubaevaG. M.

3, Togolok Moldo St., Bishkek 720040

makmal@rambler.ruРешетнякТ. М.ReshetnyakT. M.

115522, Москва, Каширское шоссе, 34А;

125993, Москва, ул. Баррикадная, 2/1, стр. 1

34A, Kashirskoe Shosse, Moscow 115522;

2/1, Barrikadnaya St., Build 1, Moscow 125993

АсееваЕ. А.AseevaE. A.

115522, Москва, Каширское шоссе, 34А

34A, Kashirskoe Shosse, Moscow 115522

СоловьевС. К.SolovyovK. S.

115522, Москва, Каширское шоссе, 34А

ДжумагуловаА. С.DzhumagulovaA. S.

720040, Бишкек, ул. Тоголока Молдо, 3

3, Togolok Moldo St., Bishkek 720040

ТкаченкоН. П.TkachenkoN. P.

720040, Бишкек, ул. Тоголока Молдо, 3

3, Togolok Moldo St., Bishkek 720040

КаримоваЭ. Р.KarimovаE. R.

720040, Бишкек, ул. Тоголока Молдо, 3

3, Togolok Moldo St., Bishkek 720040

ЖумакадыроваА. Ж.ZhumakadyrovaA. Zh.

720040, Бишкек, ул. Тоголока Молдо, 3

3, Togolok Moldo St., Bishkek 720040

ДжишамбаевЭ. Ж.DzhishambaevE. Zh.

720040, Бишкек, ул. Тоголока Молдо, 3

3, Togolok Moldo St., Bishkek 720040

ДжайлобаеваК. А.DzhailobayevaK. A.

720040, Бишкек, ул. Тоголока Молдо, 3

НасоновЕ. Л.NasonovE. L.

115522, Москва, Каширское шоссе, 34А;

119991, Москва, ул. Трубецкая, 8, стр. 2

34A, Kashirskoe Shosse, Moscow 115522;

8, Trubetskaya St., Build. 2, Moscow 119991

Национальный Центр кардиологии и терапии (НЦКТ) им. академика М. МиррахимоваКыргызстанAcademician M. Mirrakhimov National Center of Cardiology and TherapyKyrgyzstanФГБНУ «Научно-исследовательский институт ревматологии им. В.А. Насоновой»; ФГБОУ ВО «Российская медицинская академия непрерывного профессионального образования» Минздрава РоссииРоссияV.A. Nasonova Research Institute of Rheumatology; Russian Medical Academy of Postgraduate Education, Ministry of Health of RussiaRussian FederationФГБНУ «Научно-исследовательский институт ревматологии им. В.А. Насоновой»РоссияV.A. Nasonova Research Institute of RheumatologyRussian FederationФГБНУ «Научно-исследовательский институт ревматологии им. В.А. Насоновой»; ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет), кафедра ревматологии Института профессионального образованияРоссияV.A. Nasonova Research Institute of Rheumatology; Department of Rheumatology, Institute of Professional Education, I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of RussiaRussian Federation2019190320195711727Copyright © Койлубаева Г.М., Решетняк Т.М., Асеева Е.А., Соловьев С.К., Джумагулова А.С., Ткаченко Н.П., Каримова Э.Р., Жумакадырова А.Ж., Джишамбаев Э.Ж., Джайлобаева К.А., Насонов Е.Л., 20192019Койлубаева Г.М., Решетняк Т.М., Асеева Е.А., Соловьев С.К., Джумагулова А.С., Ткаченко Н.П., Каримова Э.Р., Жумакадырова А.Ж., Джишамбаев Э.Ж., Джайлобаева К.А., Насонов Е.Л.Koylubaeva G.M., Reshetnyak T.M., Aseeva E.A., Solovyov K.S., Dzhumagulova A.S., Tkachenko N.P., Karimovа E.R., Zhumakadyrova A.Z., Dzhishambaev E.Z., Dzhailobayeva K.A., Nasonov E.L.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://rsp.mediar-press.net/rsp/article/view/2669

Цель исследования – изучить нейропсихические проявления системной красной волчанки (СКВ) в киргизской когорте больных. Материал и методы. В проспективное исследование включены 460 пациентов с достоверным диагнозом СКВ, верифицированным согласно диагностическим критериям ACR (1997) и SLICC (2012), наблюдавшихся в клинике Национального Центра кардиологии и терапии им. академика М. Миррахимова (НЦКТ) с января 2012 г. по декабрь 2017 г. Признаки поражения нервной системы были выявлены у 103 (22,39%) из 460 пациентов с СКВ. С целью оценки нейропсихических проявлений СКВ (НПСКВ) использовались классификационные критерии АCR (1999). Нейропсихические нарушения диагностировались психиатром по МКБ-10. Когнитивные расстройства выявлялись психологом с применением специфического теста Mini-Mental State Examination (MMSE; мини-схема исследования психического состояния пациента). Результаты и обсуждение. Различные признаки НПСКВ были выявлены у 103 (22,39%) из 460 пациентов с СКВ. Группы пациентов с НПСКВ и без них в начале исследования были сопоставимы по возрасту, времени от появления первых признаков СКВ до верификации диагноза и по значению индекса SLEDAI-2K (p>0,05). Острый вариант течения СКВ достоверно ассоциировался с НПСКВ. Острое течение СКВ отмечалось у 56 (54,38%) из 103 пациентов с НПСКВ и у 109 (30,53%) из 357 больных без НПСКВ [отношение шансов (ОШ) 2,71 при 95% доверительном интервале (ДИ) 1,73–4,24; p<0,001]. Подострое и хроническое течение болезни выявлялось у сходного числа пациентов с НПСКВ – 24 (23,30%) и у 23 (23,33%) без НПСКВ (ОШ 5,75 при 95% ДИ 3,54–9,34; p<0,001). У большинства больных преобладало поражение центральной нервной системы (ЦНС) – у 71 (68,93%), реже выявлялась патология периферической нервной системы (ПНС) – у 32 (31,07%) из 103, а 4 (3,88%) больных имели сочетанное поражение ЦНС и ПНС. Одно проявление НПСКВ выявлялось у 37 (52,11%) больных, два – у 15 (21,13%), три – у 14 (19,72%) и четыре – у 5 (7,04%) из 71 больного с поражением ЦНС. Согласно критериям АCR (1999) у 103 пациентов было диагностировано 155 различных НПСКВ, из них 123 (79,35%) – нарушения со стороны ЦНС и 32 – ПНС (20,65%). Частота очаговых и диффузных расстройств ЦНС составила 76 (61,79%) и 47 (38,21%) соответственно. Чаще всего диагностировалась цереброваскулярная болезнь (ЦВБ) – у 33 (43,42%) из 76 случаев очаговых нейропсихических наушений ЦНС. Клинические проявления ЦВБ в основном характеризовались дисциркуляторной энцефалопатией – у 30 (90,91%), реже – ишемическим инсультом в бассейне средней мозговой артерии слева – у 2 (6,06%) и транзиторной ишемической атакой – в 1 (3,03%) из 33 случаев ЦВБ. Одно проявление было у 52,11% пациентов с патологией ЦНС. В остальных случаях отмечалось большее число симптомов ее поражения. Среди 47 диффузных поражений преобладали нейропсихические расстройства по типу психоза, основными проявлениями которого были зрительные и слуховые галлюцинации – у 34 (72,34%). Заключение. НПСКВ были выявлены у 22,39% пациентов. Острый вариант течения СКВ и очень высокая активность ассоциировались с НПСКВ. Риск развития НПСКВ при очень высокой активности СКВ был повышен в 5,75 раза. В подавляющем большинстве случаев у киргизских пациентов имело место вовлечение ЦНС (68,93%), вдвое реже – ПНС (31,07%), сочетанное поражение ПНС и ЦНС отмечалось реже (3,88%). У 47,89% больных отмечалось более одного проявления НПСКВ. У большинства больных с диффузными НПСКВ наблюдался психоз в виде зрительных и слуховых галлюцинаций (72,34%), а очаговые были представлены ЦВБ (43,42%) обычно в виде дисциркуляторной энцефалопатии (90,91%).

The aim of the investigation was to study neuropsychic manifestations (NPM) of systemic lupus erythematosus (SLE) in the Kyrgyz cohort of patients. Material and methods. The prospective study included 460 patients with a reliable diagnosis of SLE, verified according to the diagnostic criteria ACR (1997) and SLICC (2012), observed in the clinic of the Academician M. Mirrakhimov National Center of Cardiology and Therapy from january 2012 to december 2017. Signs of nervous system damage were revealed in 103 (22.39%) of 460 patients with SLE. Classification criteria of ACR (1999) were used to assess neuropsychic manifestations of SLE, which were diagnosed by the psychiatrist according to ICD-10. Cognitive disorders were detected by a psychologist using a specific test Mini-Mental State Examination (MMSE; mini-scheme study of the mental state of the patient).

Results and discussion

Results and discussion. Various signs of NPM SLE were revealed in 103 (22.39%) of 460 patients with SLE. Groups of patients with and without NPM SLE at the beginning of the study were comparable in age, time from the appearance of the first signs of SLE to the verification of the diagnosis and the value of the SLEDAI-2K index (p>0.05). Acute variant of SLE course was significantly associated with NPM SLE. The acute course of SLE was observed in 56 (54.38%) of the 103 patients with NPM SLE and 109 (30.53%) of the 357 patients without NPM SLE [odds ratio (OR) 2.71, 95% confidence interval (CI) of 1.73–4.24; p<0.001]. Subacute and chronic course of the disease was diagnosed in a similar number of patients with NPM SLE – 24 (23.30%) and without NSAIDS – 23 (23.33%) (OR 5.75 95% CI 3.54–9.34; p<0.001). In the majority of patients the central nervous system (CNS) lesions prevailed. It was present in 71 (68.93%) patients, peripheral nervous system (PNS) pathology was less frequent and revealed in 32 (31.07%) of 103 cases, and 4 (3.88%) patients had combined CNS and PNS lesions. One manifestation of NPM SLE was detected in 37 (52.11%) patients, two – in 15 (21.13%), three – in 14 (19.72%) and four – in 5 (7.04%) of 71 patients with CNS lesions. According to the criteria of ACR (1999) in 103 patients 155 different NPM SLE were diagnosed: CNS disorders – in 123 (79.35%) and PNS pathology – in 32 (20.65%). The frequency of focal and diffuse CNS disorders was 61.79% and 38.21%, respectively. Cerebrovascular disease (CVD) was diagnosed most frequently – in 33 (43.42%) of the 76 cases of focal neuropsychiatric CNS disorders. Clinical manifestations of CVD were mainly characterized by discirculatory encephalopathy – in 30 (90.91%), less often – by ischemic stroke in the middle cerebral artery basin on the left – in 2 (6.06%) and transient ischemic attack – in 1 (3.03%) of 33 CVD cases. One manifestation was present in 52.11% of patients with CNS pathology. In other cases, there were more symptoms of its damage. Among the 47 diffuse lesions, neuropsychic disorders of the psychosis type prevailed, the main manifestations of which were visual and auditory hallucinations – in 34 (72.34%) patients.

Conclusion

Conclusion. NPM SLE was identified in 22.39% of patients. Acute variant of SLE and very high activity was associated with NPM SLE. The risk of NPM SLE developing in very high activity of SLE was increased by 5.75 times. In the vast majority of cases in Kyrgyz patients there was CNS involvement (68.93%), twice less – PNS damage (31.07%), combined lesion of PNS and CNS was noted less frequently (3.88%). 47.89% of patients had more than one manifestation of NPM SLE. In most patients with diffuse NPM SLE, psychosis was observed in the form of visual and auditory hallucinations (72.34%), and focal ones were presented by CVD (43.42%), usually in the form of discirculatory encephalopathy (90.91%).

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The authors declare that there are no conflicts of interest present.