系统性红斑狼疮并发肾盂输尿管积水临床分析(附17例报告)

Clinical analysis of ureterohydronephrosis in systemic lupus erythematosus

目的探讨系统性红斑狼疮(SLE)合并肾盂输尿管积水的临床特点。方法对17例SLE合并肾盂输尿管积水(除外结核、结石及横贯性脊髓炎所致肾盂输尿管积水)病人的临床资料进行回顾性分析,并从临床特点、实验室检查和治疗及预后等方面进行总结。结果17例患者发病到检查发现肾盂输尿管积水的时间平均为25.8个月。4例肾盂输尿管积水治疗后复查B超积水情况明显改善,2例手术病人积水情况亦改善;4例无改善;6例临床情况改善,但无影像方面资料;1例死亡。合并假性肠梗阻13例(76.5%)。结论SLE合并肾盂输尿管积水并不罕见,主要发生于成人,但亦可发生于儿童;SLE合并肾盂输尿管积水的患者易出现消化道的症状特别是合并慢性假性肠梗阻,两者之间有明显相关性。通常对激素治疗有一定反应,但应早期发现,积极治疗。对发生早期梗阻性肾病肾功能不全者手术治疗仍有逆转肾功能的希望。

Objectives To explore the clinical features of ureterohydronephrosis in systemic lupus erythematosus （SLE）. Methods 17 SLE patients with ureterohydronephrosis（excluding caused by TB, stone and transverse myelitis） hospitalized in PUMC hospital between 1984 to February 2005 were analyzed retrospectively. The clinical characteristics, serological findings, treatment and prognosis of these patients were reviewed. Results The mean age of the patients was 33.2 （11～61 ）years. The ratio of female to male was 15：2. Interval from onset of disease to the discovery of ureterohydronephrosis varied from simultaneity to 12 years. After treatment the ureterohydronephrosis was improved in 6 patients which was confirmed by ultrasonography, 6 patients symptoms were improved but without repeating ultrasound examinations, 4 patients had no change. One patient died. 13 patients had chronic intestinal pseudo-obstruction at the same time. Conclusions SLE patient with ureterohydronephrosis is often present with gastrointestinal symptoms and have high incidence of chronic intestinal pseudo-obstruction. The complications can be reversed if the patients get early treatment. Surgery may be useful in treatment of renal insufficiency in the early stage.