系统性红斑狼疮并发胰腺炎46例临床分析  

Clinical analysis of 46 cases with systemic lupus-associated pancreatitis

作　　者：王强[1] 李妍[2] 沈敏[2] 冷晓梅[2] 曾小峰[2] 张奉春[2] 钱家鸣[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院消化科,100730 [2]风湿免疫科风湿免疫病学教育部重点实验室

出　　处：《中华全科医师杂志》2014年第9期737-741,共5页Chinese Journal of General Practitioners

基　　金：国家高技术研究发展计划（863计划）（2012AA02A513）;中华医学会临床医学科研专项资金（12040760376）;北京协和医院青年科研基金（2010103）

摘　　要：目的总结系统性红斑狼疮（SLE）并发胰腺炎的临床特点。方法回顾性总结1983年1月至2012年1月北京协和医院收治住院的46例SLE并发胰腺炎病例，分析其临床表现、实验室检查、影像学特点、治疗与转归。结果SLE并发胰腺炎的发生率为0．88％（46／5233），男女比例为7：39，平均年龄（33±13）岁；急性胰腺炎与慢性胰腺炎的比例为20：3（分别为40例和6例）。SLE并发胰腺炎时多系统受累明显，急性胰腺炎多发生于SLE活动期。SLE并急性胰腺炎患者中81．0％（17／21）出现高TG血症，且重症急性胰腺炎组患者TG水平显著高于轻症急性胰腺炎患者（P=0．023）。SLE并急性胰腺炎患者病死率高达37．5％（15／40），大剂量激素及免疫抑制剂治疗可缓解病情。仅有5例患者在激素冲击治疗1周之内出现急性胰腺炎，多数病情较轻。合并感染是SLE并急性胰腺炎预后不良的独立危险因素（P〈0．叭）。SLE并慢性胰腺炎临床症状相对较轻，以腹痛、黄疸、胰腺密度不均和胰腺肿大常见。1例患者以自身免疫性胰腺炎为SLE的首发表现。结论SLE并发急性胰腺炎更常见且更严重，病死率较高。伴发的高TG血症可能诱发或加重急性胰腺炎。治疗SLE并急性胰腺炎应积极联合激素和免疫抑制剂。合并感染是SLE并急性胰腺炎预后不良的独立危险因素。Objective To determine the clinical features of systemic lupus erythematosus （SLE） patients with pancreatitis. Methods The medical records of 46 patients with panereatitis among 5 233 SLE patients admitted into Peking Union Medical College Hospital from January 1983 to January 2012 were reviewed for retrospective analyses of clinical manifestations, laboratory tests, radiological findings, treatments and prognosis. Results The prevalence of pancreatitis was 0. 88% （46/5 233） in SLE patients. There were 7 males and 39 females with an average age of （33 _＋ 13） years. Acute pancreatitis （n =40） occurred more frequently than chronic pancreatitis （ n = 6）. It appeared mostly in active course of SLE with an involvement of more organs, Hypertriglyceridemia was found in 81.0% （ 17/21 ） lupus-associated acute pancreatitis patients. The average level of triglycerides in severe acute pancreatitis was higher than that in mild acute pancreatitis （P = 0. 023 ）. The mortality rate of lupus-associated acute pancreatitis was 37. 5% （15/40）. Most patients received high-dose glucocorticoid and immunosuppressants. Acute pancreatitis appeared in only 5 patients during the course of steroids pulse therapy and most symptoms were mild. Concomitant infections were correlated with poor prognosis （P 〈 0. 01 ）. The most common manifestations of lupus-associated chronic pancreatitis were abdominal pain, jaundice and pancreatic enlargement. Autoimmune pancreatitis could be the initial manifestation of lupus.

关 键 词：红斑狼疮 系统性 胰腺炎 急性坏死性 慢性 

分 类 号：R593.241[医药卫生—内科学]