系统性红斑狼疮合并假性肠梗阻7例临床分析

Seven-case analysis on intestinal pseudo-obstruction in systemic lupus erythematosus

目的分析系统性红斑狼疮(SLE)合并假性肠梗阻(IPO)的临床表现和实验室检查,提高对这种SLE类型的认识并总结治疗经验。方法回顾分析我院1990—2004年收治的7例SLE合并IPO。结果7例患者中男性1例,女性6例,平均年龄32.3岁;平均病程41个月;以IPO为首发症状4例,7例均在SLE病情活动期,合并腹腔积液4例,同时合并膀胱炎和尿路梗阻1例,7例抗核抗体均阳性,抗双链DNA抗体和抗SSA抗体阳性各4例,抗Sm抗体阳性2例,补体下降6例。用激素和环磷酰胺治疗后,7例均缓解,但其中1例治疗中出现败血症、激素减量后IPO复发而放弃治疗。结论IPO是临床少见但重要的一种SLE合并症;这种类型的SLE中IPO可为首发症状,而且常同时合并尿路梗阻和/或膀胱炎以及腹腔积液;多数患者对激素和免疫抑制剂治疗反应良好;重视多器官受累的表现以及自身抗体和补体的检测有助于及时作出正确的诊断和治疗。

Objective ①To further analyze and better understand intestinal pseudo--obstruction （IPO） in systemic lupus erythematosus （SLE） ; ②To streamline our treatment strategy for this complication. Methods Seven cases of IPO in SLE were reviewed. Results Average age of these 7 cases （1 male and 6 females） was 32.3 years,and mean SLE history was 41 months;4 cases had IPO as their initial presentation of SLE.All 7 patients were in active SLE with 2 or 3 organs involved concomitantly,including 1 ureterohydronephrosis and cystitis. All 7 patients had positive antinuclear antibody （ANA）,4 had positive anti-dsDNA and anti-SSA,2 had positive anti-Sin and complement decreased in 6. After corticosteroid and cyclophosphamide （CTX） treatment,all 7 IPO were relieved. But 1 IPO recurred complicating with septemia,this patient abandoned treatment at last. Conclusion IPO is an uncommon but severe gastrointestinal complication of SLE, being increasingly recognized recently.In this group of SLE, IPO is usually the initial presentation of SLE, and ureterohydronephrosis,cystitis and ascites are common concomitant involvements. Most patients responded to corticosteroid and immunosuppresant treatment.A high level of awareness of this complication is needed so as to timely diagnose underlying SLE and avoid unnecessary surgical intervention.