IgA血管炎中胃肠道受累的诊治现状和进展

Diagnosis and treatment of gastrointestinal involvement in IgA vasculitis

免疫球蛋白A血管炎(IgAV),是一种主要影响小血管、以IgA为主的免疫复合物沉积所引发的血管炎,可累及皮肤、关节、胃肠道和肾脏。胃肠道受累可发生于任何部位,以十二指肠降段和回肠末端较多见。症状可模拟多种胃肠道炎症或外科疾病,可在皮疹前出现,导致诊断困难、治疗延迟,消化道内镜检查有助于早期诊断。不同的分类标准在IgAV胃肠道受累诊断中各有局限。治疗上,糖皮质激素有利于改善IgAV胃肠道症状,免疫抑制剂和生物制剂的治疗作用尚不明确,需要更多的前瞻性随机对照试验来研究证实。

Immunoglobulin A vasculitis(IgAV) is caused by the deposition of immune complexes mainly IgA and affects the small-sized vessels.It can involve the skin,joints,gastrointestinal tract and kidneys.Gastrointestinal involvement can occur in any part of gastrointestinal tract,especially in the descending duodenum and terminal ileum.Symptoms which can appear before the rash mimic a variety of gastrointestinal or surgical diseases,resulting in difficult diagnosis and delayed treatment.Gastrointestinal endoscopy is helpful for early diagnosis.The different classification criteria have their own limitations in the diagnosis of gastrointestinal involvement in IgAV.Glucocorticoids can improve symptoms,but there is not enough evidence-based basis for using immunosuppressants and biological agents to gastrointestinal involvement in IgAV.It is necessary to establish more prospective randomized controlled trials,which will be helpful to individualize treatment.