以假性肠梗阻为首发症状的系统性红斑狼疮三例临床特征及诊治分析  

Clinical Features and Treatment of SLE with Intestinal Pseudo-obstruction as Initial Manifestation:Report of Three Cases

作　　者：董睿[1] 黄慧[2] 于光[1] 孙婧[1] 吴灏[1] 郭志勇[1] 崔若兰[1] 

机构地区：[1]第二军医大学附属长海医院肾内科,上海市200433 [2]第二军医大学附属长海医院内科教研室,上海市200433

出　　处：《中国全科医学》2013年第15期1759-1762,共4页Chinese General Practice

摘　　要：目的总结以假性肠梗阻(IPO)为首发表现的系统性红斑狼疮(SLE)的临床特点及诊治方法,以提高临床医师对该病的认识,减少误诊。方法回顾性分析我院收治的3例以IPO为首发表现的SLE患者的临床特点及诊治经过,并检索国内外相关文献进行复习、总结。结果该病患者临床主要表现为反复发作的恶心、呕吐、腹痛,逐渐加重,腹部X线平片显示不完全性肠梗阻,同时有浆膜腔积液、肾脏受累表现,抗核抗体、抗ds-DNA抗体、抗RNP抗体、抗SS-A抗体、抗SS-B抗体均阳性,补体C3、C4下降。经糖皮质激素治疗后病情缓解。结论以IPO为首发表现的SLE临床表现和单纯胃肠道疾病极为相似,容易误诊。需结合疾病人群特点、综合分析病史、注意胃肠道外症状(如浆膜腔积液、肾脏受累等)、结合实验室检查(如抗核抗体、抗ds-DNA抗体、抗RNP抗体、抗SS-A抗体、抗SS-B抗体及补体C3、C4)结果,提高诊断准确率,早期诊断、及时治疗,以避免不必要的手术及不良预后。Objective To summarize the clinical features, diagnosis and treatment of systemic lupus erythematosus （SLE） with intestinal pseudo - obstruction （IPO） as initial manifestation. Methods The clinical features, diagnosis and treat- ment of 3 SLE patients with IPO as initial manifestation were analyzed retrospectively, and related literatures reviewed and sum- marized. Results The main clinical manifestations were recurrent episodes of nausea and vomiting, abdominal pains and gradu- ally increased; Abdominal X - ray plain film showed incomplete intestinal obstruction, with dropsy of serous cavity and kidney involvement; Antinuclear, anti - ds - DNA, anti - RNP, anti - SS - A, anti - SS - B antibodies were positive, complements C3, C4 decreased. Condition remitted after glucocorticoid treatment. Conclusion The clinical manifestation of SLE with IPO as initial symptom, very similar to that of simple gastrointestinal disease, is extremely easy to be misdiagnosed. Diagnosis should be made by combination of population characteristics, comprehensive analysis of histories, symptoms outside gastrointestinal tract （ eg. dropsy of serous cavity and kidney involvement）, laboratory tests （ eg. antinuclear, anti - ds - DNA, anti - RNP, anti - SS - A, anti - SS - B antibodies, complements C3 andC4 ）, to improve diagnostic accuracy, early diagnosis and timely treatment to avoid unnecessary surgery or poor prognosis.

关 键 词：肠假性梗阻 红斑狼疮 系统性 临床特征 诊断 治疗 

分 类 号：R593.241[医药卫生—内科学] R574.2[医药卫生—临床医学]