系统性红斑狼疮致肾盂输尿管积水临床分析(附23例报告)

Clinical Analysis of Ureterohydronephrosis Caused by Systemic Lupus Erythematosus(Report of 23 cases)

目的:分析系统性红斑狼疮(SLE)性肾盂输尿管积水的临床特点,提高对SLE致膀胱输尿管病变的认识。方法:回顾性分析23例SLE性肾盂输尿管积水患者的临床资料:其中双侧肾积水18例(78.3%),单侧5例(21.7%);以恶心、呕吐、腹泻、腹痛、腹胀等消化道表现为首发症状者15例(65.2%);有严重尿频、尿急、急迫性尿失禁者13例(56.5%);腹水18例(78.3%);体重下降19例(82.6%)。23例均给予足量糖皮质激素联合环磷酰胺等治疗。结果:肾盂输尿管扩张明显改善13例(56.5%),其中完全缓解8例(34.8%);改善不明显10例(43.5%),其中3例行双肾造瘘术,1例行输尿管膀胱再植术,3例输尿管内留置D-J管。2例失访,2例死亡。获得随访者消化道症状均基本缓解。结论:SLE是肾盂输尿管积水的一种特殊病因;假性肠梗阻等消化道症状和严重的尿频、尿急是SLE性肾盂输尿管积水的重要临床特点;SLE性肾盂输尿管积水为可逆性病变,以药物治疗为主;早期诊断、联合肾上腺皮质激素和环磷酰胺等治疗多可缓解;内科治疗无效或并发肾功能不全者应积极行手术引流。

Objective：To investigate the clinical features of ureterohydronephrosis in systemic lupus erythematosus （SLE）, to improve the understanding of SLE causing vesical and ureteral lesions. Methods： Twenty-three SLE patients with ureterohydronephrosis were analyzed retrospectively： including bilateral renal seeper 78. 3% （18 cases）, 5 cases unilateral （21.7%）, With nausea, vomiting, diarrhea, abdominal distention, bloating, etc. Gastrointestinal manifestations as initial symptoms in 15 cases （65.2%）; serious urinary frequency, urgency, urge incontinence in 13 cases （56.5%）; ascites in 18 cases （78.3%）; weight loss in 19 cases （82.6%）. 23 cases were given sufficient quantities such as glucocorticoid and cyclophosphamide therapy. Results：Obvious improvement of ureterohydronephrosis was observed in 13 cases （56.5% ）, including 8 cases （34.8%） of complete remission. Ten patients （4a. 5%） with less change were treated with nephrostomy in 3, ureterocystoneostomy in 1 and 3 with D- J tube. Two patients died of intestinal perforation and heart disease attack respectively. Conclusions：SLE is a special cause of ureterohydronephrosis. Presenting with chronic intestinal pseudo-obstruction accompanied with urinary frequency and urgency is the most important clinical features of SLE with uieterohydronephrosis. The hydronephrosis can be reversible if an early treatment be given to the patient. Surgical drainage may be helpful in case of renal insufficiency complicated.