结节性多动脉炎胃肠道受累的临床特点分析  

Clinical characteristics of gastrointestinal involvement in polyarteritis nodosa

作　　者：霍晓聪 李淼[2] 周佳鑫 吴迪[1] 李菁[1] 徐东[1] 田新平[1] 张奉春[1] 曾小峰[1] Huo Xiaocong;Li Miao;Zhou Jiaxin;Wu Di;Li Jing;Xu Dong;Tian Xinping;Zhang Fengchun;Zeng Xiaofeng(Department of Rheumatology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College,Beijing 100032,China;Department of Rheumatology,Dalian Friendship. Hospital,Liaoning 116100,China;Department of Rheumatology,the People's Hospital of Guangxi Zhuang Autonomous Region)

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风湿免疫科,100032 [2]辽宁省大连市友谊医院风湿科,116100 [3]广西壮族自治区人民医院血液风湿免疫科

出　　处：《中华风湿病学杂志》2019年第5期295-299,共5页Chinese Journal of Rheumatology

摘　　要：目的探讨结节性多动脉炎(PAN)胃肠道受累的临床特点,进一步提高对该病的认识。方法收集2002年3月至2016年9月于北京协和医院住院治疗的PAN患者,根据临床表现和影像学检查结果分为有胃肠道受累和无胃肠道受累,分析2组患者的临床表现、实验室检查、治疗及转归。采用t检验、χ^2检验进行统计学分析。结果14年间住院治疗的PAN患者共117例。胃肠道受累的患病率为38%(44例),2组患者年龄、性别构成差异无统计学意义(P>0.05)。胃肠道受累的临床表现以腹痛(29例,66%)最为常见,其次为消化道出血(10例,23%),脾梗死(3例,7%),胃肠道溃疡(2例,5%),肠梗阻(2例,5%),腹泻(2例,5%),呕吐(1例,2%)。2组比较胃肠道受累组更易出现乏力(27%和11%;χ^2=5.156,P=0.023)和舒张压升高(55%和34%;χ^2=4.647,P=0.031),肾脏受累(34%和18%;χ^2=3.998,P=0.046)和心脏受累(25%和8%;χ^2=6.225,P=0.013)的更多,ESR升高更多(75%和56%;χ^2=4.190,P=0.041)。随访315.8(20.3,441.3)d,胃肠道受累组的复发率更高(23%和8%;χ^2=4.895,P=0.027),出现死亡及脏器不可逆损伤发生率更高(27%和11%,χ^2=5.156,P=0.023)。结论PAN合并胃肠道受累常见,其病情更严重,病情复发和出现死亡或器官不可逆损伤的发生率更高,预后更差,应引起临床医生的关注。Objective To investigate the clinical characteristics of gastrointestinal involvement in polyarteritis nodosa (PAN), and to improve the understanding of the disease. Methods PAN patients hospitalized in Peking Union Medical College Hospital from March 2002 to September 2016 were enrolled in this study, and were divided into gastrointestinal involvement group and non-gastrointestinal involvement group according to clinical manifestations and imaging findings. Data on clinical features, treatments and outcome were recorded. t test, chi-square test were used for statistical analysis. Results A total of 117 patients with PAN were hospitalized in the past 14 years. The prevalence of gastrointestinal involvement was 38%(44 cases). There was no significant difference in age and sex between the two groups (P>0.05). Abdominal pain (29 cases, 66%) was the most frequent manifestation, then gastrointestinal bleeding (10 cases, 23%), splenic infarction(3 cases, 7%), gastrointestinal ulcers (2 cases, 5%), intestinal obstruction or diarrhea (each 2 cases, 5%), and vomiting (1 case, 2%). Patients with gastrointestinal involvement had more frequent fatigue (27% vs 11%;χ^2=5.156, P=0.023), increased diastolic pressure (55% vs 34%;χ^2=4.647, P=0.031), renal (34% vs 18%;χ^2=3.998, P=0.046) and cardiac (25% vs 8%;χ^2=6.225, P=0.013) involvements. ESR in the gastrointestinal involvement group was significantly higher(75% vs 56%;χ^2=4.190, P=0.041). The average follow-up time was 315.8 (20.3, 441.3) days, the relapse rate was higher in the gastrointestinal involvement group (23% vs 8%;χ^2=4.895, P=0.027). The incidence of death or the irreversible organ injury was higher in the gastrointestinal involvement group (27% vs 11%,χ^2=5.156, P=0.023). Conclusion Gastrointestinal invol-vement in poly-arteritis nodosa is common and its condition is severe. The incidence of relapse and death or irreversible organ injury is high.

关 键 词：多动脉炎 结节性 胃肠道 体征和症状 消化系统 

分 类 号：R593.2[医药卫生—内科学]