The dissertation is dedicated to studying of neurological disorders in patients with systemic lupus erythematosus. At the work was explored the neuropsychological, neuroimaging and immunological characteristics that occur in these patients.
The dissertation research presents a method for solving of relevant problem of modern neurology and rheumatology - the prediction of the development of neurological disorders in patients with systemic lupus erythematosus and early diagnosis of these.
The research is based on data from a comprehensive prospective examination of 64 patients diagnosed with systemic lupus erythematosus, aged from 20 to 67 years.
All examined patients were divided into two groups according to the presence/absence of neurological manifestations of the disease. Into the group 1 (main) were included 54 patients with neurological symptoms, into group 2 (comparison) were included 10 patients without signs of neurological disorders.
The comparison of the study groups with each other showed that they don`t differ significantly in terms of gender, age structure, level of education (p>0.05). This confirms their comparability in terms of general characteristics and allows correctly comparison in terms of other parameters.
A comprehensive neurological examination showed that symptoms of damage to the nervous system identified with a frequency of 84.38% among the examined patients.
The study of cognitive functions according to the Montreal Cogbitive Scale Assessment showed that cognitive dysfunction was registered in 60.9% of patients. All participants with this disorder belonged to group 1.
The results of the study on the Hospital Anxiety and Depression Scale showed the presence of anxiety in 57.8% of patients. Testing with the help of the Spielberger-Hanin questionnaire allowed to assess the levels of personal anxiety and revealed mostly moderate and high levels of situational anxiety, in the comparison group - low (p = 0.001).
Depression in the examined patients was assessed using the Hospital Anxiety and Depression Scale and the Beck Depression Scale. According to the results of the assessment according to the first method, depression was found in 56.2% of the study participants, each of whom belonged to the main group. According to the Beck Depression Scale, this condition was not determined in patients of group 2, while in patients of group 1, according to the Beck scale, 24.1% had moderate depression, 33.3% had moderate depression, and 1 patient had severe depression. depression.
Structural and morphological changes in the brain in patients with systemic lupus erythematosus were assessed by magnetic resonance imaging. The most common findings were leukoaraiosis, brain atrophy, and expansion of CSF spaces. For a more detailed characterization of atrophic changes in the brain, morphometric indices were calculated to help determine the type of atrophic process. The data obtained allow us to say that patients with neurological manifestations of lupus have a cortical-subcortical type of atrophy.
A positive result for the presence of antinuclear antibodies was detected in a total of 75% of the study participants, most of whom belonged to group 1. Analysis of their patterns did not show statistically significant differences between representatives of different groups (p>0.05).
The study of lupus anticoagulant by calculating the index LA1 / LA2 showed that this type of antibody was found in 64.0% of the participants, of which the majority belonged to group 1
A blood test for the presence of anticardiolipin antibodies revealed it in 29 study participants (45.3%), all patients belonged to group 1.
To assess the ability of the studied immunological factors to predict the occurrence of neurological manifestations of lupus, an ROC analysis was performed.
Analyzing the area under the ROC-curve for immunological markers, it was found that the titer of anticardiolipin antibodies has the best operational characteristics. The optimal cut-off point for this indicator, which can be used to make a decision on the prediction of the occurrence of neurological manifestations of lupus, is a titer value of more than 2.3 IU/L.
To assess the likelihood of developing neurological disorders in patients with systemic lupus erythematosus, multiple logistic regression analysis was performed with indicators that could potentially be used as predictors. Taking into account the data obtained, an equation for predicting neurological disorders in patients with systemic lupus erythematosus was created. It has operational characteristics - sensitivity 92.6%, specificity 100.0%, area under the ROC curve - 0.981, which characterizes the predictive ability of the obtained regression equation as excellent
