系统性红斑狼疮并发慢性假性肠梗阻的临床研究

Clinical analysis of chronic intestinal pseudo-obstruction in systemic lupus erythematosus

目的探讨系统性红斑狼疮(SLE)合并慢性假性肠梗阻(CIPO)的临床特点,以提高对SLE的认识。方法对11例SLE合并假性肠梗阻患者的临床资料进行回顾性分析,并从临床特点、实验室检查、治疗及预后等方面进行总结。结果7例患者以CIPO为首发症状。10例有尿路积水,4例抗SSA抗体双扩散法阳性,7例免疫印迹法阳性,阳性率较普通SLE高。11例患者均接受足量激素治疗,9例合并应用细胞毒性药物。除1例患者因对本病认识不足所致治疗延误死亡外,其他患者的症状都有缓解。1例极早期单侧输尿管积水经治疗后消失。对大多数患者肾盂、输尿管积水的情况缓解不明显,但进展亦慢。结论SLE合并CIPO者极易合并肾盂、输尿管积水,对SLE有胃肠道表现者应注意有无肾盂、输尿管积水和膀胱炎。本病对激素治疗反应尚可,应早期发现,积极治疗。应当重视SLE合并CIPO并发症,减少不必要的手术和有创的检查。

Objectives To explore the clinical features of chronic intestinal pseudo-obstruction (CIPO) in systemic lupus erythematosus (SLE). Methods 11 SLE patients with CIPO hospitalized in PUMC hospital between 1997 to November 2004 were analyzed retrospectively. The clinical characteristics ,serological findings, treatment and prognosis of these patients were summarized. Results The mean age of the patients was 30.3(11-42) years old. The ratio of female to male was 9:2. Seven patients had CIPO as the initial presentation. An apparent association with the presence of ureterohydronephrosis was found in 10/11 patients. SSA was positive in 4 patients. All these patients received high dose of corticosteroids, cytotoxic drugs were prescribed to 9 patients. Except one patient died due to the delay of treatment, all other patients were relieved after treatment. Except one early ureterohydronephrosis disappeared after treatment, other patients ureterohydronephrosis didn't relieve significantly. Conclusions SLE patients who presented with CIPO are likely to have ureterohydronephrosis. SSA antibody can be detected in 4 patients. Response to steroid treatment is usually good. But ureterohydronephrosis may be irreversible if the treatment is delayed. Awareness of this complication is needed to avoid unnecessary surgical intervention.