Song Peng, Zhang JingCheng, Shang CongCong, Zhang Li
Department of Respiratory Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 1 Shuaifuyuan, 100730, Beijing, Dongcheng District, China.
Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
Z Rheumatol. 2019 Oct;78(8):797-802. doi: 10.1007/s00393-018-0545-z.
We analyzed four cases of systemic lupus erythematosus (SLE) with chylous pleural effusion treated in our hospital from June 2013 to May 2017. The three females and one male ranged in age from 22 to 33 years. The length of disease course was 20 to 120 months. Treatment with glucocorticoids and immunosuppressants (cyclophosphamide or cyclosporine A) did not reduce chylous pleural effusion. Lymphatic obstruction was found in all patients after direct lymphangiography and the pleural effusion was significantly reduced after surgery. A literature search identified six previously reported patients with SLE and chylous pleural effusion. Five were sensitive to classic immunosuppression treatment, probably due to early intervention. However, as shown here, the thoracic duct can be involved in SLE, leading to an intractable chylous pleural effusion with no response to medical treatment. Surgery would be a better choice when lymphatic mechanical obstruction is found.
我们分析了2013年6月至2017年5月在我院治疗的4例系统性红斑狼疮（SLE）合并乳糜性胸腔积液的病例。其中3例女性，1例男性，年龄在22至33岁之间。病程为20至120个月。使用糖皮质激素和免疫抑制剂（环磷酰胺或环孢素A）治疗并未减少乳糜性胸腔积液。所有患者经直接淋巴管造影后均发现淋巴管阻塞，手术后胸腔积液明显减少。文献检索发现6例先前报道的SLE合并乳糜性胸腔积液患者。5例对经典免疫抑制治疗敏感，可能是由于早期干预。然而，如此处所示，胸导管可受累于SLE，导致难治性乳糜性胸腔积液，药物治疗无效。当发现淋巴管机械性阻塞时，手术可能是更好的选择。
