腹膜后纤维化28例临床分析  

Clinical characteristics of retroperitoneal fibrosis:an analysis of 28 cases

作　　者：赵星星 马丹[2] 王亚静[2] 张莉芸[2] Zhao Xingxing;Ma Dan;Wang Yajing;Zhang Liyun(School of Basic Medicine,Shanxi University of Chinese Medicine,Jinzhong 030619,China;Department of Rheumatology and Immunology,Third Hospital of Shanxi Medical University,Shanxi Bethune Hospital,Shanxi Academy of Medical Sciences,Tongji Shanxi Hospital,Taiyuan 030032,China)

机构地区：[1]山西中医药大学基础医学院,晋中030619 [2]山西医科大学第三医院(山西白求恩医院山西医学科学院同济山西医院)风湿免疫科,太原030032

出　　处：《中华全科医师杂志》2022年第7期682-685,共4页Chinese Journal of General Practitioners

摘　　要：回顾性分析2014年9月至2020年9月于山西白求恩医院确诊为腹膜后纤维化(RPF)的28例患者的临床资料,包括临床表现、实验室检查、影像学特征、治疗方案及预后。28例患者男女比例1.33∶1,发病年龄(56±11)岁,以腰痛(16/28,57.14%)、腹痛(9/28,32.14%)、背痛(8/28,28.57%)为主要症状,25例(89.29%)患者炎性指标增高,3例(10.71%)患者出现肾功能不全,3例(10.71%)患者血清IgG4水平升高。Scheel影像学评估显示Ⅰ型合并Ⅲ型(腹主动脉和/或髂血管受累合并单侧或双侧输尿管受累)比例最高(50.00%,14/28)。27例(96.43%)患者给予糖皮质激素和免疫抑制剂治疗,其中14例(50.00%)患者因输尿管梗阻或肾积水行外科介入治疗,6例(21.43%)患者在激素减停过程中复发,6例(21.43%)病愈停药,13例(46.43%)患者解除输尿管梗阻和肾积水后成功拔出双J管。提示RPF好发于中老年男性,临床以腰痛多见,影像学表现以输尿管受累多见,糖皮质激素联合免疫抑制剂为常规治疗方法,外科介入可解除急性梗阻,对改善患者的预后有重要意义。Clinical data of 28 patients diagnosed with retroperitoneal fibrosis(RPF)in Shanxi Bethune Hospital from September 2014 to September 2020 were retrospectively analyzed.There were 16 males and 12 female with a mean onset age of(56±11)years.The clinical manifestations were lumbago(16/28,57.14%),abdominal pain(9/28,32.14%)and back pain(8/28,28.57%).Inflammatory indexes were elevated in 25 cases(89.29%),and 3 cases had renal insufficiency.Serum IgG4 was elevated in 3 cases(10.71%).Scheel imaging evaluation showed that proportion of typeⅠcombined with typeⅢ(abdominal aorta and/or iliac vascular involvement combined with unilateral or bilateral ureteral involvement)was the highest(50.00%,14/28).followed by.Twenty-seven patients(96.43%)were treated with glucocorticoids and immunosuppressants;14 patients(50.00%)underwent surgical intervention for ureteral obstruction or hydronephrosis;6 patients(21.43%)relapsed during hormone withdrawal;6 patients(21.43%)recovered from the disease and terminated medication;and 13 patients(46.43%)successfully removed the double J tube after lifting ureteral obstruction and hydronephrosis.It is suggested that RPF is more likely to occur in middle-aged and elderly men,with low back pain as the main clinical feature,and ureteral involvement as the main imaging feature.Glucocorticoid combined with immunosuppressive therapy is the conventional treatment.Surgical intervention can relieve acute obstruction and effectively improve the prognosis of patients.

关 键 词：腹膜后纤维化 免疫球蛋白4相关疾病 临床特征 诊断 

分 类 号：R572.2[医药卫生—消化系统]