系统性红斑狼疮合并肾盂输尿管积水患者的早期发现

目的 分析系统性红斑狼疮(SLE)相关肾盂输尿管积水的临床特点,提高早期发现SLE合并肾盂输尿管积水的能力.方法 回顾性分析本院2000-2008年SLE相关肾盂输尿管积水31例,总结其临床特点,对不同治疗时机下治疗效果进行比较,数据分析采用X2检验和t检验.结果 SLE相关肾盂输尿管积水占同期SLE住院病例1.26%(31/2468),同时合并慢性假性肠梗阻28例(90%);14例(45%)有膀胱刺激症状;双侧肾盂输尿管积水19例(61%),单侧肾盂输尿管积水8例(26%),动态观察由单侧发展至双侧肾盂输尿管积水4例(13%),双侧肾盂输尿管积水多合并膀胱壁增厚、膀胱容积变小;抗核抗体S型比例及抗SSA抗体阳性率高,均为14例(45%).31例患者均使用激素及免疫抑制剂治疗,11例完全恢复,3例无效,其中2例永久保留肾需造瘘术,1例行膀胱颈切开加输尿管膀胱再植术.结论 肾盂输尿管积水可以出现在膀胱刺激症状之前,常并发慢性假性肠梗阻,高S型ANA核型和抗SSA抗体阳性率可能是其重要免疫学特征,激素及免疫抑制剂治疗有效,早期发现、早期治疗可以改善预后.

Early diagnosis of ureterohydronephrosis in systemic lupus erythematosus

Objective To improve the ability of rheumatologist to diagnose systemic lupus erythematosus (SLE) complicated with ureterohydronephrosis by analyzing the characteristics of clinical manifestations.Methods Patients with ureterohydronephrosis hospitalized in Peking Union Medical College Hospital between 2000 to 2008 were analyzed retrospectively. The clinical characteristics, serological findings, treatment and prognosis of these patients were reviewed. Comparisons between the groups were performed with X2 test and t-test. Results SLE patient with ureterohydronephrosis accounted for 1.26% of the SLE patients hospitalized in the same period. Twenty-eight patients presented with gastrointestinal symptoms, 14 patients suffered from bladder irritative symptoms. Nineteen patients were with bilateral ureterohydronephrosis, and 8 patients were with unilateral ureterohydronephrosis. Fourteen patients had stype positive ANA, 14 patients had positive antiSSA antibodies. All patients were treated with steroid and immune suppressive therapy, 11 patients were cured, while 3 patients had no improvement. Conclusion Ureterohydronephrosis isn't a very rare complication of SLE. SLE patients with ureterohydronephrosis often present with gastrointestinal symptoms and have high incidence of chronic intestinal pseudo obstruction. High ratio of stype ANA antibody and high positive rate of anti-SSA are most important characteristics in this subtype of SLE patients. The complications can be reversed if the patients are treated early and appropritaely.