儿童系统性红斑狼疮的消化系统表现及急重症分析  

Gastrointestinal manifestations and acute abdominal pain of childhood systemic lupus erythematous

作　　者：唐晓艳[1] 李正红[1] 宋红梅[1] 何艳燕[1] 魏珉[1] 董梅[1] 

机构地区：[1]中国医学科学院,北京协和医学院,北京协和医院儿科,北京100730

出　　处：《中华实用儿科临床杂志》2014年第19期1451-1454,共4页Chinese Journal of Applied Clinical Pediatrics

摘　　要：目的 分析系统性红斑狼疮（SLE）患儿消化系统受累的临床表现,尤其是急重症表现,以提高儿科临床医师对SLE消化系统表现,尤其是急重症的认识.方法 回顾性分析2010年1月至2013年3月在北京协和医院明确诊断为SLE,且诊断年龄在16岁以下共计119例患儿的临床资料,对SLE消化系统受累临床资料进行分析.SLE诊断均符合1997年美国风湿病协会关于SLE的诊断标准,并无硬皮病和重叠综合征的临床表现.结果 SLE消化系统受累病例共24例,发生率为20.2％,平均年龄（13.5±2.0）岁（6～15岁）.男∶女为1.0∶2.4,分别占同时期诊断SLE同性别患儿的26.9％和18.3％.其中有4例患儿消化系统表现为SLE的首发症状（4/24例,16.6％）.SLE患儿消化系统受累最常见的表现为腹痛（13/24例,54.2％）,其次为恶心呕吐（11/24例,45.8％）、腹胀（4/24例,16.6％）、腹泻（3/24例,12.5％）.另有8例无明显症状,辅助检查发现肝功能异常,但无病毒感染等其他导致肝功能异常的证据.消化系统急重症表现病例共9例,6例为假性肠梗阻（2例同时合并双肾盂、输尿管扩张）;1例诊断为腹膜炎,行手术剖腹探查;1例表现为蛋白丢失性肠病;1例为急性胰腺炎.所有病例经足量激素及环磷酰胺治疗后病情好转.消化系统受累的SLE患儿合并肾盂输尿管扩张的比例高,清蛋白水平差异有统计学意义,而在是否有红细胞沉降率增快、肾脏、血液系统、中枢神经系统受累差异无统计学意义.结论 目前对儿童SLE消化系统受累认识不足,低估了SLE消化系统受累的概率及严重程度.部分患儿可以消化系统受累为首发症状,假性肠梗阻、蛋白丢失性肠病、急性胰腺炎是较为少见,但需提高认识的SLE累及消化系统重症表现.及早诊断,联合肾上腺皮质激素和环磷酰胺治疗对于消化系统急重症治疗非常重要.Objective To analyze the clinical characteristics of childhood systemic lupus erythematosus （SLE） patients with severe gastrointestinal manifestations,especially cases with acute and severe abdominal pain,so as to improve the recognition of severe and acute gastrointestinal manifestations of SLE during pediatric diagnosis and treatment.Methods Medical records of 119 patients with SLE under the age 16 years old in Peking Union Medical College Hospital from Jan.2010 to Mar.2013 were reviewed and gastrointestinal manifestations were retrospectively analyzed.All patients were diagnosed as SLE according to 1997 American College of Rheumatology （ACR） revised classification criteria.Results Gastrointestinal involvement was recorded in 24 children （20.2%）.The median （range） age at the time of initial gastrointestinal manifestations was （13.5 ± 2.0） years （6-15 years）.The ratio of female to male was 1.0 ∶ 2.4.And in 4 cases,gastrointestinal manifestations occurred as the initial symptoms.Abdominal pain was the most frequent symptom,present in 13 patients （54.2%）,11 cases （45.8%） had nausea and vomiting,4 cases （16.6%） had abdominal distension,and 3 cases （12.5%） had diarrhea.Abnormal liver function was found by lab test in 8 cases,without obvious symptoms or the proofs of any virus infection.Acute and severe abdominal pain was found in 9 cases,of whom 6 patients were diagnosed as intestinal pseudo-obstruction （2 cases with bilateral ureterohydronephrosis）,1 case had acute peritonitis with surgery,1 case was diagnosed as protein losing enteropathy and 1 case had acute pancreatitis.Liver impairment also occurred in SLE.All cases got alleviated with the treatment of steroids and immunosuppressive drugs.Significant difference was found in the occurrence of hydroureter and hydronephrosis and albumin concentrations between SLE digestive and non-digestive system involvement children.However,there was no remarkable difference in the erythrocyte sedimentation rate,or the involvement o

关 键 词：系统性红斑狼疮 消化系统 儿童 

分 类 号：R725.9[医药卫生—儿科]