系统性红斑狼疮患者1034例及伴发消化系统受累的危险因素分析

Analysis of 1034 Patients with Systemic Lupus Erythematosus and the Risk Factors of Concomitant with Gastrointestinal Manifestations

目的了解伴消化系统受累的系统性红斑狼疮(systemic lupus erythematosus,SLE)住院患者的临床及实验室检查等的特征,为其诊断及治疗等提供参考依据。方法回顾性分析1 034例SLE住院患者的临床资料,对伴有消化系统损伤的181例患者的临床表现、实验室检查、影像学检查进行回顾性分析。结果 1 034例SLE患者中,181例(17.50%)伴有消化系统损害,表现为口腔及黏膜损害34例(18.78%)、胃部病变19例(10.50%)、肠道病变15例(8.29%)、腹水45例(24.86%)、肝脏病变61例(33.70%),余7例为消化道出血、吞咽困难、急性胰腺炎等。SLE住院患者消化系统受累者与非消化系统受累者的SLEDAI评分存在差异,且以SLEDAI评分活动时受累人数多。多因素Logistics回归分析显示:抗RNP/Sm抗体和有呼吸系统疾病为危险因素(OR>1),抗RNP/SM抗体阳性消化系统受累风险增高1.678倍,SLEDAI评分趋势可提示消化系统受累风险,即每下降4分,消化系统受累的风险降低0.692倍。结论 SLE住院患者伴发消化系统受累者发病率较高,临床表现及影像学表现多样,SLEDAI评分显示病情活动时常伴消化系统受累,呼吸系统、抗RNP/Sm抗体是其危险因素。

Objective To analyze the clinical characteristics of systemic lupus erythematosus （ SLE）, focus on clinical aspects and laboratory examinations. Then, to improve the diagnosis and treatment of SLE with gastrointestinal manifestations. Methods One thousand and thirty-four hospitalized SLE patients were systematically re- viewed, focus on patients with gastrointestinal manifestations, for their demographic data, medical history,la- boratory findings,treatments. Results One hundred and eighty-one cases （ 17.50% ） had SLE-related gas- trointestinal manifestations. Of them,34 cases（ 18.78% ） had oral damage;19 cases（ 10.50% ） had stomach damage ; 15 cases （8.29 % ） had intestinal tract damage ;45 cases （24.68%） had ascites and pelvic effusion; gastrointestinal manifestations also occurred as the result of hepatic pathological changes in 61 of those cases （33.70%）. The remaining 7 cases included acute pancreatitis, upper gastrointestinal hemorrhaging, and in- testinal pseudo-obstruction. Compared with the SLE patients without gastrointestinal manifestations, the SLE- DAI score was higher in patients with gastrointestinal manifestations. Muhivariable analysis indicated RNP/ Sm, complicated with respiratory system are risk factors for GI （ OR 〉 1 ）. The risk of RNP/Sm positive pa- tients was 1. 678 times higher than negative patients. The SLEIDA score was an independent predict factor of gastrointestinal involvements （ P 〈 0.05 ）. For every drop of 4 points, the risk of a patient developing gastroin- testinal involvements reduced 0. 692 times. Conclusion The incidence of gastrointestinal complications in relations to SLE is high. Clinical manifestations and imaging manifestations are diverse. SLEDAI score activi- ties usually accompanied with gastrointestinal complications. RNP/Sm, complicated with respiratory system, SLEDIA score were independent predictors of gastrointestinal involvements.