Maruyama A, Nagashima T, Iwamoto M, Minota S
Division of Rheumatology and Clinical Immunology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan.
Lupus. 2018 Sep;27(10):1661-1669. doi: 10.1177/0961203318785770. Epub 2018 Jul 20.
This study was performed to investigate the clinical characteristics of lupus enteritis in Japanese patients with systemic lupus erythematosus (SLE). A total of 481 patients with SLE admitted to our hospital between 2001 and 2015 were retrospectively reviewed. Diagnosis of lupus enteritis was based on the following three criteria: (1) abdominal symptoms, (2) diffuse long-segment bowel thickening and (3) a requirement for glucocorticoid therapy. Lupus enteritis was identified in 17 patients (3.5%) and there were two distinct types: small intestine-dominant and large intestine-dominant. Significant differences between the two types were noted with respect to the age, frequency of biopsy-proven lupus nephritis, frequency of rectal involvement, maximum bowel wall thickness, and requirement for steroid pulse therapy. Among patients with large intestine-dominant lupus enteritis, 60% had extra-intestinal symptoms (hydroureter, bladder wall thickening, and bile duct dilatation) that are known complications of intestinal pseudo-obstruction. Two patients with large intestine-dominant lupus enteritis developed intestinal pseudo-obstruction either before or after diagnosis of lupus enteritis. Five patients (29%) developed recurrence during a median observation period of 7.2 years (1.4-14.4 years). In conclusion, large intestine-dominant lupus enteritis resembles intestinal pseudo-obstruction and these two diseases may have a common pathogenesis.
本研究旨在调查日本系统性红斑狼疮（SLE）患者狼疮性肠炎的临床特征。对2001年至2015年间我院收治的481例SLE患者进行了回顾性研究。狼疮性肠炎的诊断基于以下三个标准：（1）腹部症状，（2）弥漫性长段肠壁增厚，（3）需要糖皮质激素治疗。17例患者（3.5%）被诊断为狼疮性肠炎，分为两种不同类型：以小肠为主型和以大肠为主型。两种类型在年龄、经活检证实的狼疮性肾炎发生率、直肠受累频率、最大肠壁厚度以及是否需要脉冲类固醇治疗方面存在显著差异。在以大肠为主型的狼疮性肠炎患者中，60%有肠外症状（输尿管积水、膀胱壁增厚和胆管扩张），这些是已知的肠假性梗阻并发症。两名以大肠为主型的狼疮性肠炎患者在狼疮性肠炎诊断之前或之后发生了肠假性梗阻。5例患者（29%）在中位观察期7.2年（1.4 - 14.4年）内出现复发。总之，以大肠为主型的狼疮性肠炎类似于肠假性梗阻，这两种疾病可能有共同的发病机制。
