狼疮肠系膜血管炎的临床特征及治疗  

Clinical Characteristics and Treatment of Lupus Mesenteric Vasculitis

作　　者：陆翠[1] 胡喜梅[1] 张娟[2] 戴岷[3] 胡大伟[3] 

机构地区：[1]上海市松江区中心医院血液风湿科,201600 [2]兰州大学第一医院风湿免疫科 [3]上海交通大学医学院附属仁济医院风湿科

出　　处：《中国全科医学》2014年第17期2020-2023,共4页Chinese General Practice

摘　　要：目的分析狼疮肠系膜血管炎(LMV)患者的临床资料,提高临床医生对LMV的认识。方法收集2010年6月—2013年9月上海仁济医院风湿科确诊的28例LMV患者,回顾性分析其临床表现、合并系统损害情况、实验室检查结果、治疗及预后。结果 (1)主要临床表现:腹泻22例(78.6%),腹痛21例(75.0%),恶心和/或呕吐19例(67.9%),发热11例(39.3%)。(2)合并系统损害情况:单纯消化道受累4例(14.3%),合并1个及以上其他系统的损害24例(85.7%),其中血液系统受累16例(57.1%),14例行心脏超声检查患者中心包积液8例(57.1%),肾脏受累13例(46.4%),皮肤黏膜受累9例(32.1%),输尿管肾盂积水8例(28.6%),16例行腹部立卧位X线检查患者中假性肠梗阻(IPO)4例(25.0%),呼吸系统受累4例(14.3%)。(3)16例(57.1%)患者红细胞沉降率(ESR)升高。24例患者行血脂检查,其中66.7%(16/24)载脂蛋白A(Apo-A)水平异常(14例Apo-A水平降低,2例Apo-A水平升高),37.5%(9/24)高密度脂蛋白(HDL)水平异常(8例HDL水平降低,1例HDL水平升高)。补体C3水平下降24例(85.7%),补体C4水平下降14例(50.0%)。(4)4例合并IPO患者中3例抗SSA抗体阳性;8例合并输尿管肾盂积水患者中6例抗SSA抗体阳性;(5)23例患者行腹部CT检查,其中肠壁增厚水肿15例(65.2%);(6)均给予糖皮质激素治疗,其中26例(92.9%)患者给予中到大剂量激素治疗后有效,症状缓解,2例(7.1%)患者并发重症感染死亡。结论 LMV临床表现以腹痛、腹泻、呕吐为主,常与其他系统损害并存,多处于疾病活动;大部分患者伴ESR增快、血脂异常、补体C3及C4下降;抗SSA抗体可能与IPO及输尿管肾盂积水有关;腹部增强CT检查有助于早期诊断;多数LMV患者对大剂量激素治疗的反应效果好。Objective To identify the clinical features of lupus mesenteric vasculitis（LMV） and to enhance the understanding of LMV among clinical doctors.Methods A total of 28 patients who were diagnosed with LMV in department of rheumatism,Shanghai Renji Hospital,from June 2010 to September 2013,were selected as study subjects,the clinical manifestations,other system organ lesions,laboratory test results,treatment and prognosis were retrospectively reviewed.Results Main clinical manifestations：22（78.6%） cases had diarrhea,21（75.0%） cases had abdominal pain,19（67.9%） cases had nausea and /or vomiting,11（39.3%） cases had fever.Other system organ lesions：4（14.3%） cases had simple archenteric lesions,24（85.7%） cases had multiple system involvement（≥1 system）,16（57.1%） cases had blood system lesions,among 14 cases who received cardiac ultrasound,8（57.1%） cases had pericardial effusion,13（46.4%） cases had renal lesions,9（32.1%） cases had skin and mucosa lesions,8（28.6%） cases had hydroureter and hydronephrosis,among16 cases who performed abdomen film on erect and supine positions,4（25.0%） cases had intestinal pseudo obstruction（IPO）,4（14.3%） cases had respiratory system lesions.Increased level of ESR existed in 16（57.1%） cases,among 24cases who received blood lipid test,abnormal Apo-A level existed in 16（66.7%） cases（low Apo-A level existed in 14,high Apo-A level existed in 2）,abnormal HDL level existed in 9（37.5%） cases（low HDL level existed in 8,high HDL level existed in 1）.Decreased level of complement C3existed in 24（85.7%） cases,and decreased level of complement C4existed in 14（50.0%） cases.Among 4 cases who had both LMV and IPO,3 cases were anti-SSA positive.Besides,among 8 cases who had both LMV and hydronephrosis,6 cases were anti-SSA positive.Among 23 cases who received abdominal CT examination,15（65.2%） cases had bowel wall thickening and edema.All cases received corticosteroid treatment,symptoms improved in 26 patient

关 键 词：红斑狼疮 系统性 狼疮肠系膜血管炎 诊断 治疗 

分 类 号：R593.241[医药卫生—内科学]