Division of Rheumatology, Department of Internal Medicine, School of Medicine, Universidad de Antioquia, Hospital San Vicente Fundación, Medellín, Colombia.
Lupus. 2023 Jun;32(7):910-919. doi: 10.1177/09612033231175782. Epub 2023 May 15.
The objective is to compare the clinical and laboratory characteristics of systemic lupus erythematosus (SLE) patients with and without lupus enteritis (LE) and to identify the factors associated with the occurrence of LE.
We performed a retrospective, case-control study in hospitalized patients with SLE who were admitted to our tertiary hospital between January 2012 and December 2021. Sixteen LE patients (cases) were matched (1:3 ratio) for sex and birth year with 48 non-LE patients (controls). Univariable and multivariable logistic regression analyses were used to identify the variables associated with LE.
Of 2,479 SLE patients who were admitted to our hospital as inpatients, 16 (0.65%) were diagnosed as having LE. All patients, cases and controls, were of Mestizo ethnicity. SLE was diagnosed simultaneously with the first episode of LE in 10 (62.5%) patients. The median time from SLE diagnosis to the first episode of LE was 7 (IQR 0-78) months. LE patients had a shorter median disease duration [7 (0-78) vs 34 (9.5-79) months], and a significantly longer hospital stay (28.3 ± 15.8 vs 6.5 ± 7.9 days, < 0.001) than non-LE patients. Most LE patients (93.8%) had concomitant lupus nephritis. LE patients had higher SLEDAI-2K scores than those without LE (20.5 ± 9.4 vs 9.8 ± 10.4, < 0.001). By multivariable analysis, a higher SLEDAI-2K score (OR 1.10, 95% CI 1.02-1.18; = 0.015) was independently associated with LE occurrence after adjusting for cutaneous involvement, lymphocyte count, serum creatinine, and serum complement C4. Recurrence was observed in two patients (12.5%), both with a bowel wall thickening > 8 mm. The two patients with large intestine-dominant LE developed intestinal pseudo-obstruction. No patient had life-threatening complications (intestinal hemorrhage, infarction, or perforation), and there were no deaths induced directly by LE itself.
In patients of Mestizo ethnicity, LE occurs during the early course of SLE, frequently is one of the presenting manifestations of SLE, and in most cases, it presents with concomitant lupus nephritis. Higher levels of disease activity at diagnosis were independently associated with LE occurrence and when recurrences occur, they do so in the context of severe wall thickness.
比较狼疮性肠炎（LE）与无 LE 的系统性红斑狼疮（SLE）患者的临床和实验室特征，并确定与 LE 发生相关的因素。
我们对 2012 年 1 月至 2021 年 12 月期间在我院住院的 SLE 患者进行了回顾性病例对照研究。16 例 LE 患者（病例）按性别和出生年份与 48 例非 LE 患者（对照组）进行 1:3 配对。采用单变量和多变量逻辑回归分析来确定与 LE 相关的变量。
在我院住院的 2479 例 SLE 患者中，有 16 例（0.65%）被诊断为 LE。所有患者（病例和对照组）均为梅斯蒂索人。10 例（62.5%）患者的 SLE 诊断与首次 LE 发作同时发生。从 SLE 诊断到首次 LE 发作的中位时间为 7（IQR 0-78）个月。LE 患者的中位病程较短[7（0-78） vs 34（9.5-79）个月]，住院时间明显较长[28.3 ± 15.8 vs 6.5 ± 7.9 天， < 0.001]。大多数 LE 患者（93.8%）同时患有狼疮肾炎。LE 患者的 SLEDAI-2K 评分高于无 LE 患者[20.5 ± 9.4 vs 9.8 ± 10.4， < 0.001]。多变量分析显示，在校正皮肤受累、淋巴细胞计数、血清肌酐和血清补体 C4 后，较高的 SLEDAI-2K 评分（OR 1.10，95%CI 1.02-1.18； = 0.015）与 LE 的发生独立相关。2 例（12.5%）患者出现复发，均伴有肠壁增厚>8mm。2 例大肠优势型 LE 患者出现假性肠梗阻。无患者发生危及生命的并发症（肠出血、梗死或穿孔），也无患者因 LE 本身直接导致死亡。
在梅斯蒂索人患者中，LE 发生在 SLE 的早期，常为 SLE 的首发表现之一，且多数情况下伴有狼疮肾炎。诊断时疾病活动度较高与 LE 的发生独立相关，且在出现复发时，严重的肠壁增厚是其复发的背景。
