Nesher Gideon, Breuer Gabriel S, Temprano Katherine, Moore Terry L, Dahan David, Baer Asher, Alberton Joseph, Izbicki Gabriel, Hersch Moshe
Department of Internal Medicine A, Rheumatology Service, Shaare-Zedek Medical Center, Jerusalem, Israel.
Semin Arthritis Rheum. 2006 Feb;35(4):260-7. doi: 10.1016/j.semarthrit.2005.08.003.
Involvement of the pancreas in systemic lupus erythematosus is rare. The purpose of this article is to provide a detailed review of lupus-associated pancreatitis.
We describe 3 patients with lupus-associated pancreatitis and review the English literature of the last 30 years, including the demographic, clinical, therapeutic, and prognostic aspects of this disorder.
There were detailed descriptions of 77 patients, 88% were females. Median age was 27 years. In 44% of the patients pancreatitis developed within 1 year of the diagnosis of lupus, and 84% had active lupus at the time of pancreatitis. Abdominal pain was the most frequent pancreatitis-related symptom (88%), followed by nausea or vomiting (67%). In 97% the diagnosis of pancreatitis was based on laboratory evidence of elevated serum amylase or lipase. Abdominal computerized tomography and ultrasonography did not show signs of pancreatic involvement in 24 and 45%, respectively. The mortality rate was 27%; active lupus and some biochemical abnormalities were significantly associated with increased mortality. Treatment with corticosteroids or azathioprine was not associated with increased mortality. On the contrary, mortality was decreased in patients who were treated with these agents after the onset of pancreatitis (20% mortality, compared with 61% among those who were not treated with steroids for their pancreatitis, P = 0.005).
Pancreatitis should be suspected in any SLE patient with abdominal pain. Mortality rate is related to both active lupus and some biochemical markers. In most cases, the onset of pancreatitis appears unrelated to previous treatment with steroids or azathioprine. Moreover, treatment with these medications improves prognosis.
胰腺受累于系统性红斑狼疮较为罕见。本文旨在对狼疮相关性胰腺炎进行详细综述。
我们描述了3例狼疮相关性胰腺炎患者，并回顾了过去30年的英文文献，包括该疾病的人口统计学、临床、治疗及预后方面。
有77例患者的详细描述，其中88%为女性。中位年龄为27岁。44%的患者胰腺炎在狼疮诊断后1年内发生，84%的患者在胰腺炎发作时狼疮处于活动期。腹痛是最常见的与胰腺炎相关的症状（88%），其次是恶心或呕吐（67%）。97%的胰腺炎诊断基于血清淀粉酶或脂肪酶升高的实验室证据。腹部计算机断层扫描和超声检查分别有24%和45%未显示胰腺受累迹象。死亡率为27%；狼疮活动及一些生化异常与死亡率增加显著相关。使用皮质类固醇或硫唑嘌呤治疗与死亡率增加无关。相反，胰腺炎发作后接受这些药物治疗的患者死亡率降低（死亡率为20%，未接受类固醇治疗胰腺炎的患者死亡率为61%，P = 0.005）。
任何出现腹痛的系统性红斑狼疮患者都应怀疑有胰腺炎。死亡率与狼疮活动及一些生化指标有关。在大多数情况下，胰腺炎的发作似乎与先前使用类固醇或硫唑嘌呤治疗无关。此外，使用这些药物治疗可改善预后。
