Lian T Y, Edwards C J, Chan S P, Chng H H
Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore.
Lupus. 2003;12(8):612-6. doi: 10.1191/0961203303lu433oa.
Patients with systemic lupus erythematosus (SLE) frequently have gastrointestinal (GI) symptoms. These are usually self-limiting and related to treatment side-effects or concurrent illness. However, abdominal pain may be due to bowel ischaemia which can lead to infarction and perforation. The likelihood of these serious events is increased in individuals with pain severe enough to require assessment in hospital or a SLEDAI score > 5. This paper describes a group of patients with active SLE and GI symptoms severe enough to require admission to hospital using a retrospective review of 52 SLE patients admitted to hospital with acute abdominal symptoms. The results showed that abdominal pain (87%), vomiting (82%) and diarrhoea (67%) had been present for a mean of 4.4 +/- 6.5 days and SLEDAI score was > or = 4 in 83% of patients. CT scanning showed evidence of serositis and bowel involvement in 63% of patients who underwent this investigation. Intravenous (iv) fluids were used in 87%, parenteral steroids in 90% and iv cyclophosphamide in 31%. Most (n = 51) were discharged well. Recurrence of GI symptoms occurred in 12 patients. The conclusions are that active SLE may manifest as an acute gastrointestinal syndrome. Early diagnosis, bowel rest, supportive medical therapy and treatment with corticosteroids and/or immunosupressives can result in a good outcome.
系统性红斑狼疮（SLE）患者经常出现胃肠道（GI）症状。这些症状通常是自限性的，与治疗副作用或并发疾病有关。然而，腹痛可能是由于肠道缺血，这可能导致梗死和穿孔。在疼痛严重到需要住院评估或SLEDAI评分>5的个体中，这些严重事件的可能性会增加。本文通过对52例因急性腹部症状入院的SLE患者进行回顾性研究，描述了一组有活动性SLE且胃肠道症状严重到需要住院治疗的患者。结果显示，腹痛（87%）、呕吐（82%）和腹泻（67%）平均出现了4.4±6.5天，83%的患者SLEDAI评分≥4。CT扫描显示，在接受该检查的患者中，63%有浆膜炎和肠道受累的证据。87%的患者使用了静脉（iv）补液，90%使用了胃肠外类固醇，31%使用了静脉环磷酰胺。大多数患者（n = 51）康复出院。12例患者出现胃肠道症状复发。结论是，活动性SLE可能表现为急性胃肠道综合征。早期诊断、肠道休息、支持性药物治疗以及使用皮质类固醇和/或免疫抑制剂治疗可取得良好疗效。
