以全血细胞减少为首发症状的系统性红斑狼疮并发自身免疫性低血糖1例报告及文献复习

Systemic lupus erythematosus complicated with autoimmune hypoglycemia with pancytopenia as first manifestation:A case report and literature review

目的:分析系统性红斑狼疮(SLE)患者血液系统改变以及免疫相关性低血糖的临床特点,为SLE并发自身免疫性低血糖(AIH)的诊治提供依据。方法:收集1例以全血细胞减少为首发症状的SLE并发AIH患者的临床资料,并进行相关文献复习。结果:患者,男性,70岁,因头晕、乏力3个月、加重2周就诊。查体见睑结膜苍白,双下肺可闻及湿啰音,无其他明显阳性体征。血常规显示全血细胞减少,空腹血糖2.34mmol·L-1。行骨髓常规穿刺并观察组织病理形态表现,行风湿系列、糖代谢指标及胰岛素自身抗体(IAA)等其他相关检测,并给予相关治疗。患者既往有光过敏史,入院检查显示多浆膜积液,尿蛋白>0.5g·24h-1,全血细胞减少,抗核抗体(ANA)滴度异常,胰腺CT检查未见异常,最终临床诊断为SLE并发AIH。给予糖皮质激素治疗后,患者症状好转,全血细胞计数上升,血糖恢复正常水平。出院后继续口服糖皮质激素,规律监测血常规及血糖水平。患者全血细胞计数逐渐上升,未再出现低血糖。结论:以血液系统改变为首发症状的SLE容易被误诊,同时并发低血糖时应考虑自身抗体介导的葡萄糖稳态改变。

Objective:To analyze the hematological changes of systemic lupus erythematosus(SLE)and the clinical characteristics of immune-related hypoglycemia,and to provide the basis for the diagnosis and treatment of SLE complicated with autoimmune hypoglycemia(AIH). Methods:The clinical data a patient with SLE complicated with AIH with pancytopenia as the first manifestation were collected and the relevant literatures were reviewed.Results:A 70-year-old man was admitted to hospital because of dizziness and fatigue,and suffered from more than 3 months,aggravated for 2 weeks.The physical examination results showed pale conjunctiva,moist rales over the both lower lung and there were no other obvious positive signs.The blood test showed pancytopenia and the fasting blood glucose 2.34 mmol·L-1.The pathomorphology of tissue was observed by bone marrow puncture;rheumatism examinations,glucose metabolism indexes,insulin autoantibodies(IAA)and other assistant examinations were performed,and the patient received the related treatment.The patient had a history of photosensitivity.Admission examinations indicated multiple serous effusions,urinary protein >0.5 g·24 h-1,pancytopenia,abnormal antinuclear antibody(ANA)titer,pancreatic CT(-),and the patient was diagnosed as SLE complicated AIH finally.After treatment of prednisone,the symptoms of the patient were improved;the the whole blood count and fasting blood glucose responded well to the therapy of prednisone.After discharge from the hospital,the patient was treated with prednisone continuously and was required to regularly monitor the blood test and the blood glucose level.The patient’s whole blood count was gradually increased and no hypoglycemia occurred.Conclusion:SLE with hematological changes as the first manifestation is easily misdiagnosed.And autoantibody-mediated glucose homeostasis should be considered when SLE is complicated with hypoglycemia.