系统性红斑狼疮患者消化系统受累的临床特点及危险因素分析  

Clinical characteristics and risk factors of gastrointestinal involvement in patients with systemic lupus erythematosus

作　　者：雷玲[1] 李小芬[2] 陈战瑞[1] 覃芳[1] 文静[1] 董菲 潘婕 廖晓玲 赵铖[1] Lei Ling;Li Xiaofen;Chen Zhanrui;Qin Fang;Wen Jing;Dong Fei;Pan Jie;Liao Xiaoling;Zhao Cheng(Department of Rheumatology and Immunology,the First Affiliated Hospital of Guangxi Medical University,Nanning 530021,China;Department of Rheumatology and Immunology,Liuzhou People's Hospital,Guangxi 545006,China)

机构地区：[1]广西医科大学第一附属医院风湿免疫科,南宁530021 [2]广西壮族自治区柳州市人民医院风湿免疫科,545006

出　　处：《中华风湿病学杂志》2022年第3期160-167,共8页Chinese Journal of Rheumatology

基　　金：广西壮族自治区自然科学基金(2020JJA140100);广西医疗卫生适宜技术研究与开发课题(S201304-03);广西壮族自治区卫生厅自筹经费科研课题(Z2012068)。

摘　　要：目的研究SLE患者合并消化系统受累的临床特点及预后不良因素,提升医务工作者对SLE合并消化系统受累的认知。方法回顾性收集2012年9月1日至2019年9月1日我院收治的SLE住院患者的资料,分为2组,有消化系统病变的为消化系统受累组243例,随机抽取无消化系统病变的患者为对照组486例,采用t检验、秩和检验或χ^(2)检验,比较2组患者的临床表现、各项检查及治疗效果等,Logistic回归分析SLE合并消化系统受累的影响因素。结果①SLE合并消化系统受累的患者共243例,发生率为6.4%(243/3820),以消化系统表现为首发症状的占20.2%(49/243),常见的原因依次为狼疮性肝炎52.3%(127/243),肠系膜血管炎(LMV)35.0%(85/243),假性肠梗阻(IPO)9.9%(24/243),狼疮相关性胰腺炎8.6%(21/243),蛋白丢失性肠病(PLE)7.0%(17/243)。②与无消化系统受累的患者比较,消化系统受累组年龄较低[(38±14)岁和(32±15)岁,t=-2.47,P=0.014],中位病程短[12.0(3.0,72.0)个月和5.0(1.1,24.8)个月,Z=-5.67,P<0.001],SLEDAI评分高[(10(6,28)分和16(9,37)分,Z=2.24,P<0.001],出现皮疹(38.7%和53.5%,χ^(2)=14.46,P<0.001)、关节肿痛(36.4%和46.7%,χ^(2)=7.12,P=0.008)、心包积液(43.0%和56.4%,χ^(2)=11.53,P=0.001)、血小板下降[(216±111)×10^(9)/L和(175±114)×10^(9)/L,t=-4.69,P<0.001]、肾盂和输尿管积水(1.0%和12.8%,χ^(2)=47.47,P<0.001)的发病率高,而肺动脉高压(PAH)(31.2%和10.7%,χ^(2)=36.99,P<0.001)发病率较低;ALT[(17(10,29)U/L和59(16,127)U/L,Z=9.65,P<0.001]、AST[25.0(18.0,37.0)U/L和82.5(25.0,289.0)U/L,Z=10.57,P<0.001]、ALP[58(46,76)U/L和82(56,187)U/L,Z=8.42,P<0.001]、肌酸激酶(CK)[44.0(28.0,83.0)U/L和58.5(34.0,176.0)U/L,Z=4.46,P<0.001]、LDH[(309±206)U/L和(443±332)U/L,t=5.64,P<0.001]、空腹血糖(FBS)[(5.0±1.5)mmol/L和(5.3±1.7)mmol/L,t=2.16,P=0.031]、TG增高[(2.0±1.3)mmol/L和(2.7±2.2)mmol/L,t=4.55,P<0.001],白蛋白[(30±7)g/L和(27±7)g/L,t=5.87,P<0.001]和高密度脂蛋白(HDL)[(1.1±0.8)mmol/L和(0.9±0.5Objective To study the clinical features and prognostic risk factors of gastrointestinal(GI)involvement in systemic lupus erythematosus(SLE),and improve clinicians'understanding of GI involvement in SLE.Methods The clinical data of SLE patients admitted to the First Affiliated Hospital of Guangxi Medical University from September 1,2012 to September 1,2019 were retrospectively analyzed.Two hundred and forty-three patients with GI system involvement were the GI system affected group,and 486 patients with-out GI system involvement at the same period were randomly selected as the control group.The clinical mani-festations,laboratory tests and treatment effects of the two groups were compared by t test,Wilcoxon signed-rank test andχ^(2) test and Logistic regression was used to analyze the prognostic risk of SLE with GI system involvement.Results①There were 243 SLE patients with GI involvement,with the proportion of GI involvement in SLE patients of 6.4%(243/3820),and as the first manifestation with GI system symptoms accounted for 20.2%(49/243).The common causes were lupus hepatitis accounted for 52.3%(127/243),lupus mesenteric vasculitis(LMV)for 35.0%(85/243),pseudo Intestinal obstruction(IPO)for 9.9%(24/243),lupus-related pancreatitis for 8.6%(21/243),and protein-losing enteropathy(PLE)as 7.0%(17/243).②Compared with the control group,the group with GI involvement had a lower average age[(38±14)year vs(32±15)year,t=-2.47,P=0.014],a shorter median duration of illness[12.0(3.0,72.0)months vs 5.0(1.1,24.8)months,Z=-5.67,P<0.001],a higher median systemic lupus erythematosus disease activity index(SLEDAI)score[10(6,28)vs 16(9,37),Z=2.24,P<0.001],the occurrence of skin rash(38.7%vs 53.5%,χ^(2)=14.46),arthritis(36.4%vs 46.7%,χ^(2)=7.12,P=0.008),myositis(43.0%vs 56.4%,χ^(2)=11.53,P=0.001),pericarditis[(216±111)×10^(9)/L vs(175±114)×10^(9)/L,t=-4.69,P<0.001],thrombocytopenia,and hydroureterosis(1.0%vs 12.8%,χ^(2)=47.47,P<0.001)were high,but the incidence of pulmonary arterial hypertension(PAH)(31.2%vs 10.7%,χ

关 键 词：红斑狼疮 系统性 消化系统疾病 危险因素 预后 临床特点 

分 类 号：R593.241[医药卫生—内科学]