临床病例评析——系统性红斑狼疮患者突发喘憋意识障碍  

A systemic lupus erythematosus patient with sudden dyspnea and disordered consciousness

作　　者：宋志博[1] 韩晓宁[2] 金哲[3] 吕继成[4] 李凡[5] 耿研[1] 张卓莉[1] Song Zhibo;Han Xiaoning;Jin Zhe;Lyu Jicheng;Li Fan;Geng Yan;Zhang Zhuoli(Department of Rheumatology and Clinical Immunology,Peking University First Hospital,Beijing 100034,China;Department of Cardiovascular Disease,Peking University First Hospital,Beijing 100034,China;Department of Respiratory and Critical Care Medicine,Peking University First Hospital,Beijing 100034,China;Renal Division,Peking University First Hospital,Beijing 100034,China;Department of Neurology,Peking University First Hospital,Beijing 100034,China)

机构地区：[1]北京大学第一医院风湿免疫科,北京100034 [2]北京大学第一医院心血管内科,北京100034 [3]北京大学第一医院呼吸和危重症医学科,北京100034 [4]北京大学第一医院肾脏内科,北京100034 [5]北京大学第一医院神经内科,北京100034

出　　处：《中华风湿病学杂志》2022年第12期807-812,共6页Chinese Journal of Rheumatology

摘　　要：目的提高对重症SLE患者的识别及病因的鉴别诊断能力。方法报道1例SLE心肌受累、神经精神狼疮、血栓性微血管病等多系统受累的重症SLE患者的诊治经过,并进行分析讨论。结果青年女性,5个月前出现蛋白尿,3个月前出现双下肢水肿,1个月前出现意识改变,2 d前抽搐2次,诊断SLE,病程中先后出现神经精神狼疮,狼疮心肌受累,血栓性微血管病等多种危及生命的表现,经激素冲击,血浆置换等治疗后总体病情改善。结论SLE诊治过程中,需更早地识别SLE相关的各种复杂临床表现,及早进行干预。Objective To improve the ability of identification and differential diagnosis of severe systemic lupus erythematosus(SLE).Methods A severe SLE patient with lupus myocarditis,neuropsychiatric lupus,thrombotic microangiopathy(TMA)and other multiple system involvement was reported and discussed.Results A young female patient developed albuminuria 5 months ago,edema of both lower limbs 3 months ago,change of consciousness 1 month ago and two convulsions attack 2 days ago.She experienced life threatening manifestations such as neuropsychiatric lupus,myocardial involvement of lupus,and TMA.During the course,her condition was generally improved after glucocorticoid pulse therapy and plasma exchange.Conclusion Various complicated clinical manifestations related to SLE need to be recognized earlier and intervened as soon as possible.

关 键 词：红斑狼疮 系统性 狼疮血管炎 中枢神经系统 心肌 血栓性微血管病 

分 类 号：R593.241[医药卫生—内科学]