48例晚发型系统性红斑狼疮的临床分析

目的：分析48例晚发型系统性红斑狼疮患者的临床特征。方法：回顾性分析1995年7月～2008年6月间解放军174医院及解放军175医院住院及门诊的48例发病年龄≥50岁的SLE患者的年龄、性别、诊断时间、临床表现及诊治经过等特点,并与随机抽取的同期100例发病年龄〈50岁的SLE患者进行比较。结果：晚发组女性与男性患者的比例显著低于对照组（P〈0.01）;发病至确诊的间隔时间略长于对照组,但差异尚无统计学意义。晚发组关节炎、蝶形红斑发生率显著低于对照组（P〈0.01,P〈0.05）,而发热、高血压发生率略高于对照组,但差异无统计学意义;晚发组重要脏器受累较少（P〈0.05）,肾衰竭的发生率较低（P〉0.05）,增生性狼疮性肾炎的发生率低于对照组（P〈0.05）,尤其是弥漫增生性肾炎的发生率更低（P〈0.01）;晚发组平均每个病人的严重复发次数少于对照组（P〈0.01）;晚发组低补体血症较少见（P〈0.01）,而类风湿因子阳性率高（P〈0.05）;晚发组需要接受大剂量糖皮质激素（P〈0.01）及免疫抑制剂（P〈0.01）治疗的患者较少。结论：晚发型SLE患者病情相对较轻,较少出现严重复发,但易误诊,临床医师应加强对这一类型SLE的认识。     

男性系统性红斑狼疮临床特点分析

目的：探讨男性系统性红斑狼疮（SLE）的临床特点并与女性SLE患者进行比较。方法：收集2002年6月～2009年6月住院的64例男性SLE患者和同期425例女性患者的临床资料进行统计学对比分析。结果：两组间发病年龄差异无统计学意义。男性SLE患者家族史、以蝶形红斑为主起病的首发症状、多浆膜腔积液发生率较女性明显,但女性患者面部红斑、雷诺现象、光过敏的发生率高于男性;男性患者肾病综合征表现的发生率显著高于女性患者,而在蛋白尿、血尿、GFR下降的发生率方面差异无统计学意义;两组患者肾活检病理分型均以Ⅳ型为主,男性患者Ⅱ型、Ⅲ型所占比例低于女性,而重型病例（Ⅳ型、Ⅴ＋Ⅳ型）男性比例显著高于女性;男女两组SLE患者在ANA、dsDNA、C3、C4的阳性率相似,但男性患者抗Sm阳性率高于女性组,差异有统计学意义;男性患者好转率低于女性。结论：男性与女性SLE的临床表现有较明显差别,男性SLE病情较重,临床上要注意早期诊断,及时治疗。     

70例男性系统性红斑狼疮患者临床及肾脏病理分析

目的：探讨男性系统性红斑狼疮（SLE）患者的临床及肾脏病理特点。方法：回顾性分析了我院2003年4月～2009年4月收治的70例男性SLE患者的临床表现及肾脏病理,并对部分患者进行了随访。结果：70例男性SLE患者年龄16岁～72岁,平均（34.8±14.1）岁,临床表现肾病综合征25例、慢性肾炎19例、急性肾衰竭8例、隐匿性肾炎14例,以及尿常规检查和肾功能正常者4例。42例患者进行了肾活检,肾脏病理结果为Ⅱ型3例、Ⅲ型5例、Ⅳ型20例、Ⅴ型5例,Ⅲ＋Ⅴ型4例,Ⅳ＋Ⅴ型5例。在肾病综合征患者中21例进行了肾活检的,病理类型分别为Ⅲ型1例、Ⅳ型9例、Ⅴ型4例、Ⅲ＋Ⅴ型2例、Ⅳ＋Ⅴ型5例;在8例急性肾衰竭患者中,7例进行了肾活检,病理均为Ⅳ型。结论：男性SLE在各个年龄段均可患病,临床和肾脏病理表现多样,多数患者病情较重,但也有部分患者肾脏损害较轻。     

老年系统性红斑狼疮临床特点分析

目的：探讨老年系统性红斑狼疮（systemic lupus erythematosus,SLE）39例患者的临床表现、实验室检查及肾脏损害情况,与同期确诊的青年SLE40例患者的上述指标进行对比。方法：观察两组患者临床特点、血常规、自身抗体、蛋白尿、肾功能、活动指数（SLEDAI Score）、肾脏病理改变及治疗后感染情况。结果：老年组狼疮SLEDAI评分明显低于青年组,皮疹、狼疮脑病发生率和狼疮特异性抗体（抗ds-DNA）的阳性率显著低于青年组（P〈0.05）,但发热、关节炎高于青年组（P〈0.05）,肾脏是老年SLE的最常见累及脏器,且重型狼疮性肾炎（LN）（Ⅳ、Ⅴ型）的发病率与青年组发病的SLE无差别。老年组治疗1个月内继发感染率显著高于青年组（P〈0.05）。结论：老年SLE与青年SLE临床特征有许多不同之处,且起病隐匿,易误诊,治疗时并发症高于青年人,须谨慎用药。     

Renal and Systemic Amyloidosis in Systemic Lupus Erythematosus

A young male presented with oral ulceration for two years; swelling face and feet of seven days duration; diffuse goiter without signs of thyroid disease; normocytic normochromic anemia, thrombocytopenia, deranged renal functions, albuminuria of 2.5 g/24 h with active urinary sediment. ANA and anti-ds DNA were positive, sonography of abdomen suggested medical renal disease. Testing for HIV, HBV, VDRL, CRP, rheumatoid factor, p-ANCA and c-ANCA were negative. Thyroid hormone assays were normal. Kidney biopsy done to stage lupus nephritis did not show any evidence of lupus involvement but staining for SAA amyloid was positive. Subsequent biopsies from the liver and rectum also stained positive for amyloid. Diagnosis of “Systemic lupus erythematosus with renal and systemic secondary amyloidosis with euthyroid diffuse goiter” was made. The case is being reported and discussed because of the interesting and rare association between amyloidosis and systemic lupus erythematosus.     

Clinical Trials of Immunoadsorbent in Systemic Lupus Erythematosus Therapy

Abstract: Five patients with systemic lupus erythematosus (SLE) were perfused through an extracorporeal shunt filled with DNA-immunoadsorbent (DNA immobilized on carbonized resin beads). High concentrations of anti-DNA antibodies (36.4–67.0%) (binding percentage with ¹²⁵I-DNA) in the serum of SLE patients were reduced to 13.8–53.0%, respectively. The highest removal percentage was 62.1%. Although the decline levels varied, the symptoms of patients, i.e., long-term severe joint pain, severe edema, hydropericardium, and ascites were all relieved considerably. The immunoadsorbent showed satisfactory blood compatibility.     

系统性红斑狼疮并发门脉高压

目的:提高对以门脉高压为首发表现的系统性红斑狼疮(SLE)病人的认识.方法:报告1例特殊而临床少见、以门脉高压为首发表现SLE病例,并复习相关文献.结果:男,37岁,因"反复腹胀10年,关节痛1年,再发低热、咳嗽2周"入院.1年前因反复出现黑便,当地医院B超、胃肠钡餐诊为"门脉高压,腹水",行胃底静脉离断并脾切除术.7个月前始出现抽搐,意识障碍,考虑癫痫,予服用卡马西平、γ-氨酪酸治疗.近1年出现关节疼痛.入院后确诊为"系统性红斑狼疮,狼疮样肝炎(慢性肝炎Ⅱ级Ⅱ期),神经精神性红斑狼疮,腰椎压缩性骨折".予泼尼松联合环磷酰胺治疗,辅以抗骨质疏松药物.低热、咳嗽、气促、关节痛缓解,肝功能恢复正常,现病情稳定.结论:对非肝炎病毒感染等不明原因的门脉高压应注意排除SLE.使用脾切除及曲张静脉离断术可缓解门脉高压.糖皮质激素联合CTX治疗狼疮样肝炎可以慎用.     

Acute Abdominal Pain in Patients with Systemic Lupus Erythematosus

Background  Patients with Systemic Lupus Erythematosus (SLE) that present with acute abdominal pain (AAP) represent a challenge for the general surgeon. The purpose of this study was to identify the major causes of AAP among these patients and to define the role of disease activity scores and the APACHE II score in identifying patients with an increased perioperative risk. Methods  We conducted a prospective study of patients admitted to the ER with AAP and SLE in an 11-year period. Demographic, diagnostic, and treatment data were recorded. Systemic lupus erythematosus disease activity index (SLEDAI), systemic lupus international collaboration clinics damage index (SLICC/DI), and APACHE II Score were analyzed. The main outcome variables were morbidity and mortality within 30 days of admission. Results  Seventy-three patients were included. Ninety-three percent were female. Most common causes of AAP were: pancreatitis (29%), intestinal ischemia (16%), gallbladder disease (15%), and appendicitis (14%). Most causes of AAP in patients with LES were not related to the disease. APACHE II score > 12 was statistically associated with the diagnosis of intestinal ischemia compared to other causes. No relationship was observed between SLEDAI and outcome. Furthermore, this index did not have impact on diagnosis or decision making. Overall morbidity was 57% and overall mortality 11%. On multivariate analysis, only APACHE II > 12 was associated with mortality (P = 0.0001). Conclusion  This is one of the largest series of AAP and SLE. Most common causes of AAP were pancreatitis and intestinal ischemia. APACHE II score in patients with intestinal ischemia was higher than those with serositis; further studies are needed to examine whether this score may help to differentiate these ethiologies when CT findings are inconclusive. APACHE II score was the most important factor associated with mortality. Furthermore, a prompt diagnosis and an appropriate surgical management are essential in order to improve patient outcome.     

A Case of Acute Pancreatitis in a Patient with Systemic Lupus Erythematosus

Systemic lupus erythematosus (SLE) is an auto-immune disease which can affect multiple organs. It may also involve the pancreas and in rare cases may cause acute pancreatitis. The etiology of acute pancreatitis in SLE is a matter of controversy. We present a case diagnosed with SLE that developed acute pancreatitis while being treated with cor-ticosteroids. During the course of the disease, pancreatic pseudocysts developed and were treated by percutaneous drainage. There are few reports in the literature about the therapy of acute pancreatitis and percutaneous drainage of pseudocysts in SLE. We discuss the pathogenesis and therapy for acute pancreatitis in SLE patients.