Effects of glucocorticoids and cyclophosphamide and hydroxychloroquine sulfate on resting brain function in systemic lupus erythematosus patients without major neuropsychiatric manifestations
Objective By analyzing resting state functional magnetic resonance imaging data,this study aims to explore the effects of glucocorticoids(GC),glucocorticoids combined with cyclophosphamide(CTX)and/or hydroxychloroquine sulfate(HCQ)treatment on brain function in systemic lupus erythematosus patients without major neuropsychiatric manifestations,providing a basis for early identification and intervention of changes in brain function in systemic lupus erythematosus patients without major neuropsychiatric manifestations.Methods Systemic lupus erythematosus patients without major neuropsychiatric manifestations were divided into drug naïve group,GC group,and GC combined with CTX and/or HCQ group based on their treatment status at the time of enrollment.Health controls(HCs)were selected based on gender,age,and education level.The low frequency amplitude(ALFF),fractional low frequency amplitude(fALFF),and regional homogeneity(ReHo)were calculated for each of the four groups of participants.When comparing multiple groups,x2 test or Fisher's exact test was used for count data,analysis of variance or Kruskal-Wallis H test was used for continuous variables,and LSD method was used for post hoc comparisons.Results After matching,22,30,50,and 29 cases were finally included.There were significant differences in brain function in multiple brain regions among the four groups.Specifically,compared with the HCs group,the ALFF values of the right posterior central gyrus(t=-2.96)and the right paracentral lobule(t=-2.95)in the drug naïve group were decreased.In the GC group,the ALFF values in the right paracentral lobule(t=-2.93),the right posterior central gyrus(t=-2.93)and the right anterior central gyrus(t=-2.94)were decreased.The ALFF values of the right paracentral lobule(t=-2.90)and the right anterior central gyrus(t=-2.90)were decreased in GC+CTX and/or HCQ groups.Compared with the drug naïve group,ALFF values were higher in the right posterior central gyrus(t=-3.00)and the right rolandic operculum(t=-2.91)in GC+CTX and/or HCQ groups.Compared with the HCs group,fALFF values of the right anterior central gyrus(t=-2.95)and the left posterior central gyrus(t=-2.97)in the drug naïve group decreased,and fALFF values of the right anterior central gyrus(t=-2.94)and the left posterior central gyrus(t=-2.98)in the GC group decreased.fALFF values decreased in the left posterior central gyrus(t=-2.91)of GC+CTX and/or HCQ groups.fALFF values in the right anterior central gyrus(t=-2.89)were higher in GC+CTX and/or HCQ group than in GC group.Compared with HCs,the ReHo value in the right posterior central gyrus(t=-2.97)of the drug naïve group decreased,and the ReHo value in the right anterior central gyrus(t=-2.95)of the GC group decreased.The ReHo of GC+CTX and/or HCQ group was higher in the right anterior central gyrus(t=-2.91)than that of the drug naïve group,and the ReHo of the right posterior central gyrus(t--2.93)was higher than that of the GC group.The above results were adjusted by Gaussian random-field(GRF)multiple comparison(Pvoxel＜0.005,Pcluste＜0.010).Conclusion Systemic lupus erythematosus patients without major neuropsychiatric manifestations have reduced functional activity in multiple brain regions of the whole brain.GC combined with CTX and/or HCQ may have better effects on improving brain function than GC alone,and it mainly acts on sensorimotor related brain regions.
Lupus erythematosus,systemic,without major neuropsychiatric manifestationsGlucocorticoidsImmunosuppressantBrain function
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