系统性红斑狼疮并急性胰腺炎6例临床分析及文献复习

目的:初步探讨系统性红斑狼疮(SLE)合并急性胰腺炎的临床特点、可能病因机制和治疗方法。方法:回顾性分析上海仁济医院风湿免疫科住院治疗的SLE合并急性胰腺炎患者6例。观察其临床表型、生化检查、影像及免疫学等检查,并复习主要的文献。结果:SLE患者胰腺炎的临床表现以腹痛、恶心、呕吐、中上腹压痛反跳痛为主,血、尿淀粉酶升高,自身抗体阳性,影像学检查胰腺增大表现,常伴血液系统损害,低补体血症。急性轻型胰腺炎3例,重型胰腺炎3例。所有患者均给予中到大剂量糖皮质激素治疗,痊愈4例,1例并发狼疮脑病、脑白质病变遗留智力障碍和肢体运动功能障碍,1例并发颅内新型隐球菌感染后死亡。结论:急性胰腺炎是SLE病情活动的表现与激素无明显关系,常伴其他系统损害,病情恢复较慢,合并颅内病变预后差,糖皮质激素治疗是安全有效的。

Clinical analysis of systemic lupus erythematosus complicated with acute pancreatitis in 6 cases and literature review

Objective To preliminarily explore the clinical features,possible etiology and treatment methods of systemic lupus erythematosus （SLE） complicated with acute pancreatitis.Method Six cases with SLE complicated with acute pancreatitis hospitalized in Shanghai renji hospital were retrospectively analyzed.The clinical phenotype,biochemical examination,imaging and immunological exam were observed,and the main literatures were reviewed.Results The main clinical manifestations of SLE patients with pancreatitis were abdominal pain,nausea,vomiting,tenderness and rebound pain in middle and upper abdomen,blood and urinary amylase rase,autoantibodies were positive,imaging showed pancreas augmentation,commonly associated with blood system damages and hypocomplementemia.Acute mild pancreatitis in 3 cases and severe pancreatitis in 3 cases.All the cases were given middle to large dose of glucocorticoid treatment.Four cases were cured,1 was complicated with lupus encephalopathy and cerebral white matter changes,left mental disorder and limb movement dysfunction,1 was died because of intracranial cryptococcal infection.Conclusion Acute pancreatitis is the manifestation of active SLE and has no relationship with hormone,commonly associates with damages in other systems and slowly condition recovery.Poor prognosis in cases is associated with intracranial lesions and glucocorticoid treatment is safe and effective.