D⁃二聚体在系统性红斑狼疮肠系膜血管炎早期诊断中的临床意义  

Clinical significance of D⁃dimer in early diagnosis of mesenteric vasculitis in systemic lupus erythematosus

作　　者：马晓蕾[1] 毛琦[2] 王红[1] 华冰珠[1] 陈智勇[1] 李幼生 MA Xiao⁃lei;MAO Qi;WANG Hong;HUA Bing⁃zhu;CHEN Zhi⁃yong;LI You⁃sheng(Department of Immunology and Rheumatology,the Affiliated Drum Tower Hospital of Nanjing University Medical School,Nanjing 210008,Jiangsu,China;Department of Surgery,Jinling Hospital,General Hospital of Eastern Theater Command,PLA,Nanjing 210002,Jiangsu,China;Department of General Surgery,Ninth People′s Hos⁃pital,Shanghai Jiao Tong University School of Medicine,Shanghai 200011,China)

机构地区：[1]南京大学医学院附属鼓楼医院风湿免疫科,南京210008 [2]东部战区总医院(原南京军区南京总医院)全军普通外科研究所,南京210002了 [3]上海市第九人民医院普外科,上海200011

出　　处：《医学研究生学报》2020年第6期604-608,共5页Journal of Medical Postgraduates

基　　金：国家自然科学基金(81601418)。

摘　　要：目的系统性红斑狼疮肠系膜血管炎(LMV)可导致小肠广泛坏死,且疾病早期极易误诊漏诊。文中旨在评估就诊首日血清D⁃二聚体水平在LMV早期诊断中的临床意义。方法回顾性分析2006年1月至2019年1月南京鼓楼医院收治的38例系统性红斑狼疮(SLE)患者。其中15例LMV患者(LMV组),非LMV患者23例(非LMV组)。统计分析主要观察指标为2组患者就诊首日血清D⁃二聚体水平,次要观察指标包括患者一般情况、SLE活动度评分(SLEDAI)、增强CT检查结果、实验室检查结果及治疗后血清D⁃二聚体水平。结果2组患者年龄、SLE患病周期及SLEDAI等指标差异无统计学意义(P>0.05)。入院时CT可见LMV患者肠管扩张、肠系膜水肿及典型“靶”样征,大剂量激素治疗后,扩张肠管及肠壁显著缓解,出院前CT“靶”样征消失。LMV组患者就诊首日血清D⁃二聚体水平[917(756,1848)μg/L]显著高于非LMV组[570(356,896)μg/L],差异有统计学意义(P=0.006)。ROC曲线分析结果显示,血清D⁃二聚体早期诊断LMV的临界值为624μg/L,敏感性与特异性分别为93%、61%,AUC=0.77。结论血清D⁃二聚体水平可作为LMV患者早期诊断的有效指标。Objective Lupus mesenteric vasculitis(LMV)can lead to extensive necrosis of the small intestine,and it is easy to be misdiagnosed and missed in the early stage of the disease.This study aims to evaluate the clinical significance of serum D⁃di⁃mer level in the early diagnosis of LMV.Methods Retrospective analysis was performed on 38 patients with systemic lupus erythematosus(SLE)admitted to Nanjing Drum Tower Hospital from January 2006 to January 2019.There were 15 LMV patients(LMV Group)and 23 non⁃LMV patients(Non⁃LMV Group).The main ob⁃servation indicators of statistical analysis were serum D⁃dimer level on the first day of treatment in the two groups,while the secondary indi⁃cators included patient general condition,SLE disease activity index(SLEDAI),enhanced CT examination results,laboratory examination results and serum D⁃dimer level after treatment.Results There was no significant difference in age,SLE duration and SLEDAI be⁃tween the two groups(P>0.05).On admission,CT showed LMV patients with intestinal dilatation,mesenteric edema and typical tar⁃get symptoms.After high⁃dose hormone therapy,the dilatation of intestinal canal and intestinal wall were significantly relieved,and the target signs on CT disappeared before discharge.The serum D⁃dimer level of patients in the LMV Group[917(756,1848)μg/L]was significantly higher than that in the Non⁃LMV Group[570(356,896)μg/L],and the difference was statistically significant(P=0.006).ROC curve analysis showed that the critical value of serum D⁃dimer in early diagnosis of LMV was 624μg/L,and the sensitiv⁃ity and specificity were 93%and 61%,respectively(AUC=0.77).Conclusion Serum D⁃dimer level can be used as an effective index for early diagnosis of LMV patients.

关 键 词：系统性红斑狼疮肠系膜血管炎 D⁃二聚体 系统性红斑狼疮 诊断 

分 类 号：R593.24[医药卫生—内科学]