ArticleClinical rheumatology2026
Glymphatic dysfunction in systemic lupus erythematosus.
Article in Clinical rheumatology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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11 authors.
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Abstract
objectivesThis study aims to assess the activity of the glymphatic system in patients with neuropsychiatric systemic lupus erythematosus (NPSLE) and non-NPSLE using diffusion tensor imaging analysis along the perivascular space (DTI-ALPS) and explore the potential correlation between the DTI-ALPS index and clinical indicators. MATERIALS AND
methodsA total of 33 non-NPSLE patients, 13 NPSLE patients, and 33 age-matched healthy controls (HC) were enrolled in this study. Clinical indicators of patients were recorded, and DTI images were obtained to determine diffusivity along the x-, y-, and z-axes at the level of the lateral ventricle body. The DTI-ALPS index was calculated, and one-way ANOVA analysis with Bonferroni post hoc tests was used to assess differences among HC, non-NPSLE, and NPSLE. Pearson or Spearman correlation analysis was applied to investigate the correlation between DTI-ALPS index and clinical indicators. According to the SLEDAI scores, 44 SLE patients (non-NPSLE, n = 31; NPSLE, n = 13) were categorized into four groups, and one-way ANOVA analysis with Bonferroni post hoc tests was used to compare the ALPS index among the four groups.
resultsCompared to the healthy control (HC) group (1.705 ± 0.167), the ALPS index in the total SLE group (1.507 ± 0.138) was significantly lower [t (77) = 3.921, P < 0.001]. Both the NPSLE group (1.550 ± 0.113, n = 33) and non-NPSLE group (1.578 ± 0.148, n = 13) exhibited significantly reduced ALPS index in comparison with the HC group. One-way ANOVA showed a significant group effect on the ALPS index [F (2,76) = 7.775, P < 0.001]. Bonferroni-corrected post hoc tests indicated that the HC group had a higher ALPS index than the non-NPSLE group [mean difference = 0.127, 95% confidence interval (CI) (0.036, 0.219), P_adj = 0.003], and higher than the NPSLE group [mean difference = 0.155, 95% CI (0.033, 0.277), P_adj = 0.008]. The NPSLE was lower than that of the non-NPSLE, but this difference was not statistically significant (P_adj = 1.000), which may be partly due to the small NPSLE sample size. And we classified total SLE patients into four grades based on their SLEDAI scores. One-way ANOVA demonstrated a significant difference in ALPS index among the four SLEDAI grades [F (3, 40) = 3.210, P = 0.033]. After Bonferroni correction, only the difference between Grade 1 and Grade 3 remained significant (P_adj = 0.029); all other comparisons were not significant. Addition, no significant correlations were found between DTI-ALPS index and various clinical indicators, including serum C3, C4, CH50, anti-Smith antibodies, and SLEDAI scores.
conclusionThe DTI-ALPS index can serve as a noninvasive imaging biomarker for assessing glymphatic system function in non-NPSLE and NPSLE patients. These findings contribute to a better understanding of the pathophysiological mechanisms of SLE. Key Points • The pathological mechanism of SLE may be related to functional impairment of the glymphatic system. • DTI-ALPS index may serve as an MR biomarker for SLE patients.
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