系统性红斑狼疮继发反复细菌性尿路感染1例并文献复习  

Recurrent bacterial urinary tract infection secondary to systemic lupus erythematosus,a case report and literature review

作　　者：蔡金云 王旋 陈娟[1] 付萍[1] CAI Jinyun;WANG Xuan;CHEN Juan;FU Ping(The Second Affiliated Hospital of Kunming Medical University,Kunming,Yunnan,650101,China;Department of Rheumatology and Immunology,Panzhihua Central Hospital,Panzhihua,Sichuan,617000,China;Yijishan Hospital Affiliated to Wannan Medical College,Wuhu,Anhui,241000,China)

机构地区：[1]昆明医科大学第二附属医院风湿免疫科,云南昆明650101 [2]攀枝花市中心医院风湿免疫科,四川攀枝花617000 [3]皖南医学院附属弋矶山医院,安徽芜湖241000

出　　处：《当代医学》2022年第6期39-43,共5页Contemporary Medicine

摘　　要：目的提高对神经系统查体阳性的系统性红斑狼疮(systemic lupus erythematosus,SLE)患者合并神经源性膀胱需考虑SLE合并横贯性脊髓炎可能的认识。方法本文对1例SLE合并神经源性膀胱继发反复细菌性尿路感染的病例进行分析,并复习相关文献。结果患者为22岁男性,诊断SLE 15年,外院诊断为“脊髓横贯损伤、神经源性膀胱”4年,腹壁反射、深反射亢进,病理反射阳性,双下肢痛觉过敏、肌力减低,肌张力减低。考虑患者神经源性膀胱功能障碍继发反复细菌性尿路感染由SLE合并横贯性脊髓炎引起,复查腰椎MRI正常,AQP4阴性,但由于患者经济原因未查其他部位脊髓MRI,未能明确诊断损伤部位,泌尿外科会诊建议行膀胱扩大手术改善症状。结论本例诊治经验提示,SLE合并神经源性膀胱的患者若继发反复细菌性尿路感染,且神经系统查体阳性,需考虑SLE合并横贯性脊髓炎可能,在控制原发疾病及尿路感染等相关并发症的同时需完善脊髓MRI检查以明确诊断。Objective To improve the understanding of(systemic lupus erythematosus,SLE)with neurogenic bladder with positive neurological examination,it is necessary to consider the possibility of SLE complicated with transverse myelitis.Methods A case of recurrent bacterial urinary tract infection secondary to neurogenic bladder in SLE was analyzed,and the related literature was reviewed.Results The patient was a man with 22 year old,diagnosed with SLE for 15 years,transverse injury of spinal cord and neurogenic bladder for 4 years.The abdominal wall reflex and deep reflex were hyperreflex,pathological reflex was positive,hyperalgesia,myodynamia and myotonia of both lower limbs were decreased.Considering that the recurrent bacterial urinary tract infection secondary to neurogenic bladder dysfunction was caused by SLE complicated with transverse myelitis,checking again,the lumbar MRI was normal and AQP4 was negative.But we couldn't get other parts of the spinal cord injury information due to economic reasons.Urological consultation suggested bladder enlargement surgery to improve the symptoms.Conclusion In patients with SLE complicated with neurogenic bladder,if recurrent bacterial urinary tract infection is secondary and neurological examination is positive,the possibility of SLE complicated with transverse myelitis should be considered.Spinal cord MRI examination should be improved to confirm the diagnosis while controlling the primary disease and urinary tract infection and other related complications.

关 键 词：系统性红斑狼疮 横贯性脊髓炎 神经源性膀胱 细菌性尿路感染 

分 类 号：R593.241[医药卫生—内科学]