系统性红斑狼疮伴发肠系膜血管炎临床分析

摘要

[OBJECTIVE]Objective:To improve the understanding of the clinical manifestations,diagnosis and treatment of patients with systemic lupus erythematosus complicated with mesenteric vasculitis.Methods:Data of 258 patients with systemic lupus erythematosus complicated with mesenteric vasculitis in China in recent 10 years were analyzed.Results:Two hundred and fifty eight cases of systemic lupus erythematosus complicated with mesenteric vasculitis were all in the active stage,among which the most common clinical manifestations were abdominal pain(74.03%),diarrhea(65.12%),nausea and vomiting(60.08%);the most common system damages were renal damage(46.12%)and blood system damage(37.21%);and the test indexes showed leukopenia(42.35%),C3 decrease(85.84%),C4 decrease(76.54%)and anti-SSA antibody increase(56.19%), which had diagnostic implications.Abdominal plain iflm showed intestinal obstruction (45.07%),suggesting the disease be easy to be combined with intestinal obstruction.Abdominal CT examination showed a typical "target" sign(33.33%),and "comb-shaped" or "palisade-shaped" mesenteric vessels(25.60%).Hormone and immunosuppressant(93.41%)were effective in the treatment.Conclusion:Systemic lupus erythematosus complicated with mesenteric vasculitis has low incidence and high mortality,with abdominal pain being the most common clinical manifestation.Abdominal CT is of great signiifcance to the diagnosis.Early diagnosis and treatment can improve the prognosis and reduce the mortality rate.%目的：提高对系统性红斑狼疮伴发肠系膜血管炎患者临床表现、诊断及治疗的认识。方法：分析近10年国内报道的258例系统性红斑狼疮伴发肠系膜血管炎患者的诊治资料。结果：258例均为系统性红斑狼疮伴发肠系膜血管炎活跃期患者，临床表现最多见的是腹痛（74.03%），腹泻（65.12%），恶心、呕吐（60.08%）；最常合并的系统损害为肾脏损害（46.12%），血液系统损害（37.21%）；检验指标发现白细胞减少（42.35%），补体C3降低（85.84%），补体C4降低（76.54%），抗SSA抗体升高（56.19%）有诊断提示作用。腹部平片示肠梗阻（45.07%），考虑本病易合并假性肠梗阻。腹部CT检查可见典型的“靶形”征（33.33%），肠系膜血管“梳状”或“栅栏状”（25.60%）。激素及免疫抑制剂治疗有效（93.41%）。结论：系统性红斑狼疮伴发肠系膜血管炎发病率低，死亡率高，腹痛为最主要的临床表现，腹部CT对诊断意义重大，早期诊断及治疗可改善该疾病的预后，降低病死率。