CAJ | 학술논문

目的总结系统性红斑狼疮(SLE)并发胰腺炎的临床特点.方法回顾性总结1983年1月至2012年1月北京协和医院收治住院的46例SLE并发胰腺炎病例,分析其临床表现、实验室检查、影像学特点、治疗与转归.结果 SLE并发胰腺炎的发生率为0.88％(46/5 233),男女比例为7∶39,平均年龄(33 ± 13)岁;急性胰腺炎与慢性胰腺炎的比例为20∶3(分别为40例和6例).SLE并发胰腺炎时多系统受累明显,急性胰腺炎多发生于SLE活动期.SLE并急性胰腺炎患者中81.0％(17/21)出现高TG血症,且重症急性胰腺炎组患者TG水平显著高于轻症急性胰腺炎患者(P=0.023).SLE并急性胰腺炎患者病死率高达37.5％(15/40),大剂量激素及免疫抑制剂治疗可缓解病情.仅有5例患者在激素冲击治疗1周之内出现急性胰腺炎,多数病情较轻.合并感染是SLE并急性胰腺炎预后不良的独立危险因素(P＜0.01).SLE并慢性胰腺炎临床症状相对较轻,以腹痛、黄疸、胰腺密度不均和胰腺肿大常见.1例患者以自身免疫性胰腺炎为SLE的首发表现.结论 SLE并发急性胰腺炎更常见且更严重,病死率较高.伴发的高TG血症可能诱发或加重急性胰腺炎.治疗SLE并急性胰腺炎应积极联合激素和免疫抑制剂.合并感染是SLE并急性胰腺炎预后不良的独立危险因素.
목적 총결계통성홍반랑창(SLE)병발이선염적림상특점.방법 회고성총결1983년1월지2012년1월북경협화의원수치주원적46례SLE병발이선염병례,분석기림상표현、실험실검사、영상학특점、치료여전귀.결과 SLE병발이선염적발생솔위0.88％(46/5 233),남녀비례위7∶39,평균년령(33 ± 13)세;급성이선염여만성이선염적비례위20∶3(분별위40례화6례).SLE병발이선염시다계통수루명현,급성이선염다발생우SLE활동기.SLE병급성이선염환자중81.0％(17/21)출현고TG혈증,차중증급성이선염조환자TG수평현저고우경증급성이선염환자(P=0.023).SLE병급성이선염환자병사솔고체37.5％(15/40),대제량격소급면역억제제치료가완해병정.부유5례환자재격소충격치료1주지내출현급성이선염,다수병정교경.합병감염시SLE병급성이선염예후불량적독립위험인소(P＜0.01).SLE병만성이선염림상증상상대교경,이복통、황달、이선밀도불균화이선종대상견.1례환자이자신면역성이선염위SLE적수발표현.결론 SLE병발급성이선염경상견차경엄중,병사솔교고.반발적고TG혈증가능유발혹가중급성이선염.치료SLE병급성이선염응적겁연합격소화면역억제제.합병감염시SLE병급성이선염예후불량적독립위험인소.
Objective To determine the clinical features of systemic lupus erythematosus (SLE) patients with pancreatitis.Methods The medical records of 46 patients with pancreatitis among 5 233 SLE patients admitted into Peking Union Medical College Hospital from January 1983 to January 2012 were reviewed for retrospective analyses of clinical manifestations,laboratory tests,radiological findings,treatments and prognosis.Results The prevalence of pancreatitis was 0.88％ (46/5 233) in SLE patients.There were 7 males and 39 females with an average age of (33 ± 13) yeats.Acute pancreatitis (n =40) occurred more frequently than chronic pancreatitis (n =6).It appeared mostly in active course of SLE with an involvement of more organs.Hypertriglyceridemia was found in 81.0％ (17/21) lupus-associated acute pancreatitis patients.The average level of triglycerides in severe acute pancreatitis was higher than that in mild acute pancreatitis (P =0.023).The mortality rate of lupus-associated acute pancreatitis was 37.5％ (15/40).Most patients received high-dose glucocorticoid and immunosuppressants.Acute pancreatitis appeared in only 5 patients during the course of steroids pulse therapy and most symptoms were mild.Concomitant infections were correlated with poor prognosis (P ＜ 0.01).The most common manifestations of lupus-associated chronic pancreatitis were abdominal pain,jaundice and pancreatic enlargement.Autoimmune pancreatitis could be the initial manifestation of lupus.Conclusions Pancreatitis with SLE includes acute and chronic pancreatitis.Among them,acute pancreatitis is more common and severe and it usually occurs in patients with active SLE with a high mortality.Hypertriglyceridemia may induce and aggravate lupus-associated acute pancreatitis.Early aggressive management with high-dose steroids and immunosuppressants is recommended.Concomitant infection is a risk factor of poor prognosis.