第482例——呕吐,发作性头晕,皮肤无汗  

The 482nd case: vomiting, paroxysmal dizziness and anhidrosis

作　　者：姜梦迪 赵久良[1,2] 周央中 蒋颖 张烜[1] 曾小峰[1,2] Jiang Mengdi;Zhao Jiuliang;Zhou Yangzhong;Jiang Ying;Zhang Xuan;Zeng Xiaofeng(Department of Rheumatology and Clinical Immunology,Peking Union Medical College Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing 100730,China;National Clinical Research Center for Dermatologic and Immunologic Diseases,Beijing 100730,China;Department of Internal Medicine,Peking Union Medical College Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing 100730,China)

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,100730 [2]国家皮肤与免疫疾病临床医学研究中心,北京100730 [3]中国医学科学院/北京协和医学院/北京协和医院内科,100730

出　　处：《中华内科杂志》2020年第12期1013-1016,共4页Chinese Journal of Internal Medicine

摘　　要：患者女,31岁。因反复呕吐、腹痛2年,加重伴头晕1个月就诊北京协和医院。患者于2年前诊断系统性红斑狼疮(消化道、泌尿道平滑肌受累),药物规律治疗。近1个月出现反复呕吐伴恶心,查脑脊液白细胞总数0,氯化物113 mmol/L,蛋白0.24 g/L,葡萄糖3.4 mmol/L;头颅及脊髓磁共振成像(MRI)未见异常,腹部影像学、胃肠镜大致正常。住院期间先后新发体位性低血压(站立位血压80/50 mmHg,心率102次/min;卧位血压125/80 mmHg,心率97次/min),仰卧位血压夸张性波动。结合其近两年性欲减低,体检发现左侧瞳孔强直,皮肤不对称出汗异常,皮肤交感反射试验异常,考虑系统性红斑狼疮累及自主神经病变,静脉点滴甲泼尼龙(1 g,3 d)联合静脉输注免疫球蛋白(20 g,3 d)治疗,患者症状明显改善。通过分析本例患者的临床资料,提高临床医师对系统性红斑狼疮继发自主神经系统受累的认识。A 31-year-old woman was admitted to Peking Union Medical College Hospital presented with intermittent vomiting and abdominal pain for 2 years,and recurrence with paroxysmal dizziness for 1 month.This patient was diagnosed with systemic lupus erythematosus(SLE)2 years ago with involvement of gastrointestinal and urinary tracts.One month ago,repeated vomiting and nausea recurred.No laboratory and imaging abnormalities were found in central nervous system and gastrointestinal evaluation.Orthostatic hypotension and fluctuation of blood pressure were recorded during hospitalization.Combined with sexual dysfunction,left adie pupil,anhidrosis and abnormal sympathetic skin response,autonomic nerve dysfunction related to SLE was diagnosed.After treated with pulse glucocorticoids and intravenous immunoglobulin,the patient′s symptoms improved remarkably.Orthostatic hypotension in SLE patients may link to autonomic nerve dysfunction.

关 键 词：红斑狼疮 系统性 自主神经系统 低血压 

分 类 号：R576[医药卫生—消化系统] R593.241[医药卫生—内科学]