Clinical analysis of 61 systemic lupus erythematosus patients with intestinal pseudo-obstruction and/or ureterohydronephrosis: a retrospective observational study.
Clinical analysis of 61 systemic lupus erythematosus patients with intestinal pseudo-obstruction and/or ureterohydronephrosis: a retrospective observational study.
复制标题
61 例系统性红斑狼疮合并假性肠梗阻和/或输尿管肾积水患者的临床分析：一项回顾性观察研究。
DOI：
10.1097/md.0000000000000419
复制
发表时间：
2015-01
期刊：
影响因子：
1.6
通讯作者：
Zhang F
中科院分区：
文献类型：
--
作者：
Xu N;Zhao J;Liu J;Wu D;Zhao L;Wang Q;Hou Y;Li M;Zhang W;Zeng X;Fang W;Huang X;Zhang X;Tian X;Zhao Y;Zeng X;Zhang F
本文旨在探讨系统性红斑狼疮(SLE)并发假性肠梗阻(IPO)和/或输尿管肾积水的临床特点。对61例合并IPO和/或输尿管积水的系统性红斑狼疮患者进行了回顾性分析。从同期住院的3840例无IPO、无输尿管积水的SLE患者中随机抽取183例作为对照。将患者分为3组(SLE合并输尿管积水、SLE合并输尿管积水、SLE合并输尿管积水)。比较3组患者的临床特点、治疗方法及预后。其中女性57例，男性4例，平均年龄32.0岁。以IPO为首发表现的SLE占49.1%，以输尿管肾积水为首发表现的占32.5%。所有患者最初都接受了大剂量类固醇治疗。其中31名患者(50.8%)还接受了静脉甲基强的松龙冲击治疗。2例死于肠穿孔和狼疮性脑病，其余59例(96.7%)经治疗后缓解。有IPO和/或输尿管肾积水患者发热、肾小球肾炎、神经系统损害、浆膜炎、血沉升高、低蛋白血症、低补体血症和抗SSA抗体阳性的发生率明显高于对照组(无IPO和输尿管肾积水)。此外，IPO和/或输尿管积水患者的SLE疾病活动指数评分也高于对照组。与SLE合并IPO患者相比，IPO合并输尿管积水患者胆囊壁增厚、胆道扩张和浆膜炎的发生率明显增加，而输尿管积水患者皮肤黏膜受累和浆膜炎的发生率较低。在最初对免疫治疗反应良好的47名IPO患者中，有8人复发；然而，通过适当的免疫治疗再次治疗，所有人的反应都很好。在这8名患者中，4名患者因依从性差和自行停止类固醇或免疫抑制治疗而复发。复发IPO组患者免疫治疗依从性差的发生率和受累器官数显著高于未复发IPO组。IPO和输尿管肾积水是SLE的严重并发症。由于患者通常对早期最佳的激素治疗反应良好，早期诊断和及时应用糖皮质激素对于缓解症状、预防并发症和改善预后至关重要。
The objective of this article is to investigate the clinical features of intestinal pseudo-obstruction (IPO) and/or ureterohydronephrosis in systemic lupus erythematosus (SLE). Sixty-one SLE patients with IPO and/or ureterohydronephrosis were analyzed retrospectively. A total of 183 cases were randomly selected as controls from 3840 SLE inpatients without IPO and ureterohydronephrosis during the same period. Patients were assigned to 1 of the 3 groups (SLE with IPO and ureterohydronephrosis, SLE with IPO, and SLE with ureterohydronephrosis). The clinical characteristics, treatments, and prognosis were compared between the 3 groups. There were 57 females and 4 males, with a mean age of 32.0 years. IPO was the initial manifestation of SLE in 49.1% of the cases, whereas ureterohydronephrosis in 32.5%. All patients were initially treated with a high-dose steroid. Thirty-one of these patients (50.8%) also received intravenous methylprednisolone pulse therapy. Two patients died of bowel perforation and lupus encephalopathy, and the other 59 patients (96.7%) achieved remission after treatment. The incidences of fever, glomerulonephritis, nervous system involvement, serositis, erythrocyte sedimentation rate elevation, hypoalbuminemia, hypocomplementemia, and anti-SSA antibody positivity were significantly higher in patients with IPO and/or ureterohydronephrosis than in the control group (without IPO and ureterohydronephrosis). Also, patients with IPO and/or ureterohydronephrosis had higher SLE Disease Activity Index scores than control patients. Compared with SLE patients with IPO, the patients with IPO and ureterohydronephrosis had a significantly higher incidence of gallbladder wall thickening, biliary tract dilatation, and serositis, whereas the patients with ureterohydronephrosis had less mucocutaneous involvement and serositis. Eight of the 47 IPO patients who initially responded well to immunotherapy relapsed; however, all responded well to retreatment with adequate immunotherapy. Of these 8 patients, 4 relapsed following poor compliance and self-discontinuation of steroid or immunosuppressant therapy. The rate of poor compliance with immunotherapy and the number of organ systems involved in patients in the recurrent IPO group were significantly higher than those in the nonrecurrent IPO group. IPO and ureterohydronephrosis are severe complications of SLE. As patients usually respond readily to early optimal steroid treatment, early diagnosis and timely initiation of glucocorticoid are important to relieve symptoms, prevent complications, and improve prognosis.