结缔组织疾病所导致急腹症的临床特点分析

Clinical analysis on acute abdomen caused by connective tissue diseases

目的分析结缔组织疾病所导致急腹症的诊治特点。方法对我院2006年5月—2011年7月收治的215例结缔组织疾病导致急腹症患者进行疾病分析,统计其临床表现及治疗方式等,探讨诊治特点。结果系统性红斑狼疮患者(SLE组)临床症状主要表现为腹痛(64.1%)及恶心呕吐(56.4%),结节性多动脉炎患者(PAN组)主要表现为恶心呕吐(85.5%),白塞病患者(BD组)主要表现为腹痛(69.3%)及恶心呕吐(84.0%),三组患者均较多出现恶心呕吐现象,临床表现无明显统计学差异。SLE组患者平均SLEDAI评分为(3.8±1.6)分,均低于5分,平均活动度71.0%,均高于60.0%;PAN组患者中,95.2%(59/62)患者乙肝表面抗原呈阳性,40.4%(25/62)患者出现血便并伴有不完全肠梗阻、腹膜炎等病症;BD组患者内镜可见回盲部肠管黏膜存在单个或多个圆形溃疡,边缘清晰,多数溃疡底部覆以黄白苔。结论结缔组织疾病患者在出现急腹症时均存在不同程度的腹痛、恶心呕吐现象,SLE患者多见SLEDAI评分≤5分,活动度≥60.0%等特征;PAN患者多为乙肝病毒携带者,且出现血便特征;BD患者内镜可见肠管及口腔黏膜溃疡现象,上述特异性指征可作为临床诊断结缔组织病导致急腹症的主要依据。而在治疗中,均以应用糖皮质激素及免疫抑制剂为主,必要时可采取手术治疗。

Objective To analyze the characteristics of diagnosis and treatment of acute abdomen caused by connective tissue diseases. Methods A total of 215 patients with acute abdomen resulting from connective tissue diseases, who were admitted to our hospital from May 2006 to July 2011, were analyzed in the respects of clinical manifestation, diagnosis and treatment. Results In systemic lupus erythematosus （SLE） group, the clinical symptom was focused on abdominal pain （ 64.1% ） and nausea and vomi- ting （56.4%） ; in polyarteritis nodosa （PAN） group, it was focused on nausea and vomiting （85.5%） ; in Behcet disease （BD） group it was focused on abdominal pain （69.3%） and nausea and vomiting （84%）. Nausea and vomiting were common in the three groups, and there were no statistical differences in clinical manifestation. The mean SLEDAI score of the SLE group was 3.8 ＋ 1.6, less than 5, and the average degree was 71% , higher than 60%. In the PAN group, 95.2% （59/62） of the patients were positive in hepatitis B surface antigen, 40.4% （25/62） of those had bloody stool and suffered from incomplete intestinal ob- struction, peritonitis and other diseases. In the BD group, single or multiple circular ulcer（s） in ileocecal mucosa with clear edge and yellow-white moss in the base was （were） found via endoscopy. Conclusion When the patients suffer from acute abdomen re- sulting from connective tissue disease, the clinical manifestation consists of abdominal pain, nausea and vomiting. The patients with SLE possess a SLEDAI score ~〈 5 and activity degree ≥ 60%, those with PAN are hepatitis B virus carriers, and those with BD suffer from endoscopic visible intestinal and oral mueosal ulcer phenomenon. The above specific indications act as main basis for the clinical diagnosis of connective tissue diseases causing acute abdomen. Treatment includes the use of eorticosteroids and immuno- suppressive agents, and surgical operation is also taken into account if necessary.