儿童系统性红斑狼疮消化系统受累临床表现及诊治进展

Clinical manifestations and progress in diagnosis and treatment of digestive system involvement in children with juvenile systemic lupus erythematosus

儿童系统性红斑狼疮(JSLE)消化系统受累比较常见,15%~60%的JSLE患儿有胃肠道受累表现,2%~30%的胃肠道症状直接归因于JSLE。JSLE的主要病理改变为炎症反应和血管异常,症状不具有特异性,临床可表现为狼疮性肠系膜血管炎、肝炎、胰腺炎等,因此早期认识具有重要意义。针对具有消化系统表现的JSLE患儿,应根据实验室客观依据明确原因,对因治疗;一旦明确消化系统表现为JSLE本身病变所致者,应予足量糖皮质激素早期静脉使用,必要时予冲击疗法等。文章综述JSLE消化系统受累的病因病理、临床表现、诊断和鉴别诊断以及治疗进展,为进一步完善适用于JSLE累及消化系统的诊疗规范提供建议。

Digestive system involvement is common in juvenile systemic lupus erythematosus(JSLE).Gastrointestinal involvement occurs in 15%to 60%of children with JSLE,and 2%to 30%of gastrointestinal symptoms are directly attributable to JSLE.The main pathological changes of JSLE are inflammation and vasculitis,and the symptoms are not specific.Clinically,it can be manifested as lupus mesenteric vasculitis,hepatitis and pancreatitis,so early recognition is of great significance.For children with JSLE who present with digestive system symptoms,the cause should be identified based on objective laboratory findings and treated accordingly.Once it is clear that the digestive system is caused by JSLE itself,adequate glucocorticoids should be used intravenously at an early stage,and pulse therapy should be given if necessary.This paper reviews the progress of etiology,pathology,clinical manifestations,diagnosis,differential diagnosis and treatment of JSLE digestive system involvement,and provides suggestions for further improving the diagnosis and treatment norms applicable to JSLE digestive system involvement.