以消化系统表现为首发症状的系统性红斑狼疮30例临床分析  

The clinical analysis of 30 cases of systemic lupus erythematosus with first digestive system symptoms

作　　者：王斌[1] 李向培[2] 汪国生[2] 厉小梅[2] 

机构地区：[1]安徽淮南市第一人民医院普内科,232007 [2]安徽省立医院风湿免疫科

出　　处：《中国临床保健杂志》2009年第1期37-40,共4页Chinese Journal of Clinical Healthcare

摘　　要：目的分析以消化系统表现为首发症状的系统性红斑狼疮(SLE)的临床特征,以提高对该病临床多样性的认识和诊治水平。方法回顾性总结和分析30例以消化系统表现为首发症状的SLE患者的临床和实验室资料,并以关节痛和(或)皮疹首发的60例SLE患者作为对照组。结果SLE消化系统为首发症状者误诊率高达50%,首发症状以腹痛最多见(12例)。影像学检查显示病变累及消化系统多个部位,表现形式多样。与对照组相比确诊时间明显缩短(P<0.05)、补体C3水平显著下降(P<0.05)、肝酶水平升高。对照组以关节炎/关节痛、皮疹、光过敏、脱发多见,抗核小体抗体水平显著升高(P<0.01)和抗Sm抗体阳性率显著增高(P<0.05)。消化道症状在大剂量激素治疗10 d左右缓解。结论SLE消化系统受累表现形式多样,作为首发表现时常引起误诊。大剂量激素有明显疗效。Objective To heighten the understanding of the clinical diversity and the level of diagnosis and treatment of Systemic Lupus erythematosus （SLE） First with Digestive System Symptoms through the analysis of its clinical characteristics. Methods Reviewing and analyzing the clinical and laboratory data of 30 patients with SLE First with Digestive System Symptoms, and comparing the data with that of 60 patients with SLE First with arthralgia and/or erythra. Results The findings indicated that up to 50 percent of SLE First with Digestive System Symptoms are misdiagnosed, and the commonest symptom is abdominal pain （12 cases in 30）. Iconographical tests showed that SLE may affect various places in the digestive system with multiple manifestations. Compared to 60 patients with SLE First with arthralgia and/or erythra,the time between the first attack of SLE First with Digestive System Symptoms to the definite diagnosis was shortened, and there were striking statistical differences between them （ P 〈 0.05 ）, and a significant decrease in the indices of complement-3 （P 〈 0. 05 ） and a significant increase in the indices of aminopherase in the cases of SLE First with Digestive System Symptoms. In the cases of SLE First with arthralgia and/or erythra,the commonest symptoms were arthritis/arthralgia, erythra, photosensitization, lipsotrichia, and was a significant increase in the indices of anti-nucleosome antibodies （P 〈 0.01 ） and in the rate of anti-Sin positive （P 〈 0. 05 ）. The digestive system symptoms can be mitigated after a high dosage treatment of glucocorticoids for 10 days. Conclusions There are multiple manifestations of SLE attacking the digestive system, that the cases of SLE first with digestive system symptoms are frequently misdiagnosised. Clinical practices demonstrate that a significant curative effect can be expected by a high-dosage use of glucocorticoids.

关 键 词：红斑狼疮 系统性 症状和体征 消化系统 误诊 

分 类 号：R593.241[医药卫生—内科学]