狼疮肠系膜血管炎临床特征和危险因素分析

Clinical Characteristics and Risk Factors of Lupus Mesenteric Vasculitis

目的观察狼疮肠系膜血管炎(LMV)的临床特征并分析其危险因素。方法回顾性分析郑州大学第一附属医院2013年7月至2020年7月收治的系统性红斑狼疮(SLE)患者的临床资料,以48例合并LMV的患者(合并LMV组)和50例未合并LMV的患者(未合并LMV组)为研究对象。总结两组临床表现、实验室检查结果、影像学特征,分析SLE合并LMV的危险因素。结果LMV临床特征以腹痛、恶心呕吐、腹泻、腹胀等腹部表现为主,常合并多浆膜腔积液和呼吸系统受累。与未合并LMV组比较,合并LMV组患者淋巴细胞计数、补体C3滴度、血清白蛋白水平较低(P<0.05),D-二聚体、系统性红斑狼疮疾病活动指数(SLEDAI)、红细胞沉降率(ESR)、尿蛋白阳性率、腹水阳性率较高(P<0.05)。LMV的CT影像学特征有肠系膜脂肪密度增高、肠壁增厚、肠段扩张、腹水、“靶征”,可合并尿路损伤表现。多因素logistic回归分析显示:补体C3滴度下降(OR=0.014,P=0.046)、D-二聚体水平升高(OR=10.001,P=0.014)、腹水(OR=26.980,P=0.007)是LMV发生的独立危险因素。结论LMV常合并多浆膜腔积液和呼吸系统受累,补体C3滴度下降、D-二聚体水平升高及腹水是SLE合并LMV的独立危险因素。

Objective To observe the clinical features of lupus mesenteric vasculitis(LMV)and analyze the related risk factors.Methods The clinical data of patients with systemic lupus erythematosus(SLE)admitted to the First Affiliated Hospital of Zhengzhou University from July 2013 to July 2020 were retrospectively analyzed.Forty-eight patients with LMV(LMV group)and 50 patients without LMV(non-LMV group)were the research objects.The clinical manifestations,laboratory findings,and imaging characteristics of the two groups were summarized,and the risk factors of SLE combined with LMV were analyzed.Results The clinical features of LMV were mainly abdominal manifestations such as abdominal pain,nausea and vomiting,diarrhea,and abdominal distension,often associated with multiple serous effusions and respiratory system involvement.Compared with non-LMV group,LMV group had lower lymphocyte count,complement C3 titer,and serum albumin level(P<0.05),and higher D-dimer level,systemic lupus erythematosus disease activity index(SLEDAI),erythrocyte sedimentation rate(ESR),positive rate of urine protein,and positive rate of ascites(P<0.05).The CT imaging features of LMV included increased mesenteric fat density,thickening of the intestinal wall,dilatation of the intestinal segment,ascites,and“target sign”,which might be accompanied by urinary tract injury.Multivariate logistic regression analysis showed that decreased complement C3 titer(OR=0.014,P=0.046),increased D-dimer level(OR=10.001,P=0.014),ascites(OR=26.980,P=0.007)were independent risk factors for SLE combined with LMV.Conclusion LMV is often associated with multiple serous effusions and respiratory system involvement.Decreased complement C3 titer,increased D-dimer level and ascites are independent risk factors for SLE with LMV.