系统性红斑狼疮合并TMA一例

A case of systemic lupus erythematosus combined with thrombotic microangiopathy

一例早期确诊为系统性红斑狼疮的青年女性,病程长且反复发作,随着病程进展出现严重的血液系统损害,完善相关检查及肾活检后最终确诊为“狼疮肾炎Ⅳ+Ⅴ型伴TMA肾损伤”。予以激素冲击联合血浆置换、环磷酰胺联合贝利尤单抗免疫抑制治疗,取得较好效果。本病例警示临床医生对于狼疮肾炎的鉴别诊断,需考虑肾血管病变的存在,并积极治疗。

A young woman,formerly diagnosed as systemic lupus erythematosus,had a long and recurrent course of the disease and severe hematologic damage as the disease progressed,was finally diagnosed as"lupus nephritis type IV+V with thrombotic microangiopathy(TMA)renal injury"after completing relevant examinations and renal biop-sy.She was treated with hormone shock combined with plasma replacement and cyclophosphamide combined with beli-mumab immunosuppressive therapy,and achieved good results.This case warns clinicians of the differential diagnosis of lupus nephritis and the need to consider the presence of renal vascular lesions and to treat them aggressively.