BRAIN and NERVE－神経研究の進歩68巻9号

2016年09月発行

特集 自己免疫性脳炎・脳症

SLE脳症

著者： 田中良哉¹

所属機関： ¹産業医科大学医学部第1内科学講座

ページ範囲：P.1035 - P.1048

文献概要

全身性エリテマトーデス（SLE）は，妊娠可能年齢の女性に好発し，多臓器障害をもたらす代表的な全身性自己免疫疾患（膠原病）である。特に，中枢神経病変は予後を規定する要因である。障害部位は中枢神経，脊髄，末梢神経と幅広く，その症候は器質的なものから精神医学的所見まで非常に多彩である。米国リウマチ学会では神経精神SLE（NPSLE）としてSLEにおける精神症状・神経症候を19病型に細分類した。また，欧州リウマチ学会は2008年にSLEの管理，2010年にNPSLEの管理・治療のガイドラインを発表した。NPSLEなどの重症臓器病変があれば，大量ステロイド剤と免疫抑制薬の併用療法の開始が選択される。本邦でも複数の免疫抑制薬が承認され，寛解導入，臓器障害の阻止，QOLの改善へと治療目標が高くなってきた。今後は，生物学的製剤やキナーゼ阻害薬の開発が期待される。

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