风湿

狼疮患者何症状下考虑狼疮性膀胱炎

作者:作者:Koh JH 翻译:北医三院刘蕊(maryllr@163.com) 发布:柴静 审核:赵金霞 来源:中国风湿病公众论坛 日期:2017-08-11
导读

         狼疮患者有胃肠道或下尿路症状时,应考虑狼疮性膀胱炎

关键字:  狼疮性膀胱炎 

        本研究旨在探讨狼疮性膀胱炎的临床特征,并确定系统性红斑狼疮(SLE)患者狼疮性膀胱炎的危险因素和临床疗效。我们回顾性地收集了1998年至2013年在韩国首尔首尔圣玛丽医院的1064例患者资料。24名患者患有狼疮性膀胱炎。狼疮性膀胱炎被定义为通过成像研究,膀胱镜检查或膀胱组织病理学检测,并排除尿道微生物感染或结石的不明原因的输尿管炎和/或膀胱炎。四分之三的狼疮性膀胱炎患者合并狼疮性肠系膜血管炎(LMV)。在大多数患者中最初的症状为胃肠道(79.2%)表现。大多数狼疮性膀胱炎的患者(91.7%)开始时服用高剂量的甲泼尼龙。两名患者(8.3%)死于尿路感染。纳入其他表现的65例年龄和性别匹配的SLE患者作为对照组。患有狼疮性膀胱炎的患者在入院时显示存在较低水平的C3(p = 0.031),更高的SLE疾病活动指数得分(p = 0.006)和较高的ESR(p= 0.05)。同没有发生过狼疮性膀胱炎的对照组患者相比,膀胱炎组患者入院前经常有LMV病史(p <0.001);而没有发生神经精神狼疮史(p = 0.031)。狼疮性膀胱炎的发生与LMV病史有关(OR,21.794; 95%CI,4.061-116.963)。中位随访期为3.4年,累计一年死亡率为20%。 33.3%的狼疮性膀胱炎患者出现并发症,与生存率相关(log-rank p = 0.021)。我们的研究结果表明,当SLE患者存在LMV病史并出现胃肠道症状或下尿路症状时,应考虑存在狼疮性膀胱炎的可能性。狼疮性膀胱炎患者出现并发症可能是致命的。因此,需要强化治疗和随访,特别是在存在并发症的情况下。

        附全文:Abstract:This study was performed toinvestigate the clinical characteristics of lupus cystitis and determine therisk factors and clinical outcomes of lupus cystitis in patients with systemiclupus erythematosus (SLE). We retrospectively reviewed 1064 patients at SeoulSt. Mary's Hospital in Seoul, Korea, from 1998 to 2013. Twenty-four patientshad lupus cystitis. Lupus cystitis was defined as unexplained ureteritis and/orcystitis as detected by imaging studies, cystoscopy, or bladder histopathologywithout urinary microorganisms or stones. Three-fourths of patients with lupuscystitis had concurrent lupus mesenteric vasculitis (LMV). The initial symptomswere gastrointestinal in nature for most patients (79.2%). High-dose methylprednisolonewas initially administered to most patients (91.7%) with lupus cystitis. Twopatients (8.3%) died of urinary tract infections. Sixty-five age- andsex-matched patients with SLE who were admitted with other manifestations wereincluded as the control group. Patients with lupus cystitis showed a lower C3level (p=0.031), higher SLE Disease Activity Index score (p=0.006), andhigher ESR (p=0.05) upon admission; more frequently had a history ofLMV prior to admission (p<0.001); and less frequently had a history ofneuropsychiatric lupus (p=0.031) than did patients with SLE but without lupuscystitis. The occurrence of lupus cystitis was associated with a history of LMV(OR, 21.794; 95% CI, 4.061-116.963). The median follow-up period was 3.4 years,and the cumulative one-year mortality rate was 20%. Complications developed in33.3% of patients with lupus cystitis and were related to survival (log-rank p=0.021). Ourresults suggest that the possibility of lupus cystitis should be consideredwhen a patient with SLE and history of LMV presents with gastrointestinalsymptoms or lower urinary tract symptoms. Development of complications inpatients with lupus cystitis can be fatal. Thus, intensive treatment andfollow-up are needed, especially in the presence of complications.

        引自:Koh JH1, Lee J1, Jung SM1, Ju JH1, Park SH1, Kim HY2, Kwok SK3.Lupus cystitis in Korean patients with systemic lupus erythematosus: riskfactors and clinical outcomes.Lupus. 2015 Oct;24(12):1300-7. doi: 10.1177/0961203315588575.Epub 2015 Jun 1.

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