李皎宇;陈志威;李磊;叶霜;
LI Jiao-yu;CHEN Zhi-wei;LI Lei;YE Shuang;Department of Rheumatology,South Campus,Ren Ji Hospital,School of Medicine,Shanghai Jiaotong University;Department of Radiology,South Campus,Ren Ji Hospital,School of Medicine,Shanghai Jiaotong University;

• 1:上海交通大学医学院附属仁济医院南院风湿科
• 2:上海交通大学医学院附属仁济医院南院放射科

摘要(Abstract)：

目的通过分析系统性红斑狼疮(systemic lupus erythematosus,SLE)胃肠道受累患者腹部CT的特征性病变,建立CT评分系统并分析其临床评估价值。方法回顾性分析2013年9月至2018年5月上海交通大学医学院附属仁济医院风湿科收治的SLE胃肠道受累患者的临床资料,记录患者CT影像学下的肠壁厚度及肠内外受累部位,建立CT评分系统,分析CT评分系统与患者肠道功能恢复时间、住院天数、系统性红斑狼疮疾病活动指数(systemic lupus erythematosus disease activity index,SLEDAI)及实验室观察指标的关系。结果共63例SLE胃肠道受累患者纳入本研究,其中女性60例,男性3例,平均年龄(36. 7±13. 1)岁,SLE病程4 (1～8)年; 54例(85. 7%,54/63)患者存在胃肠道病变,31例(49. 2%,31/63)出现肠外脏器受累,肠壁厚度平均(7. 8±3. 7) mm。CT评分与肠道功能恢复时间呈正相关(r=0. 365,P=0. 003);低分组(CT评分≤2)与高分组(CT评分>2)相比,肠道功能恢复时间更短[(7. 9±6. 2) d比(15. 8±13. 8) d,P=0. 006)],住院天数更短[(17. 1±9. 0) d比(25. 7±20. 5) d,P=0. 043)],SLEDAI更低[(7. 6±4. 4)分比(12. 2±7. 2)分,P=0. 004],接受大剂量激素治疗的患者数量更少(60. 7%比88. 6%,P=0. 010)。结论 CT评分系统可用于评估SLE胃肠道受累患者疾病严重程度。
Objective The aim of this study was to develop a CT image-based evaluation system for systemic lupus erythematosus( SLE) associated with gastrointestinal involvement. Methods The clinical data of SLE patients with gastrointestinal( GI) involvement from September 2013 to May 2018 were retrospectively analyzed. The bowel wall thickness and extra-GI organs involvement were recorded by CT imaging. A new CT scoring system was established. Then the relationship between the CT score and the time to GI functional recovery,the length of hospital stay,the systemic lupus erythematosus disease activity index( SLEDAI),and laboratory findings were analyzed. Results A total of 63 SLE patients with GI involvement were enrolled,including 60 females and3 males with a mean age of( 36. 7 ± 13. 1) years and SLE duration of 4( 1-8) years; 54 patients( 85. 7%,54/63) had GI tract thickness/edema; 31 patients( 49. 2%,31/63) had extra-GI involvement; the average intestinal wall thickness was( 7. 8 ± 3. 7) mm. CT score was positively correlated with the time of GI functional recovery( r = 0. 365,P = 0. 003). Compared to those with a CT score >2,patients with a CT score ≤2 had a shorter time of GI recovery [( 7. 9±6. 2) d vs.( 15. 8±13. 8) d,P = 0. 006) ],a shorter length of hospital day [( 17. 1±9. 0) d vs.( 25. 7±20. 5) d,P = 0. 043) ],a lower SLEDAI( 7. 6± 4. 4 vs. 12. 2 ± 7. 2,P = 0. 004); and were less likely to receive higher dose of corticosteroids( 60. 7% vs. 88. 6%,P = 0. 010). Conclusion The CT scoring system can be used to assess the severity of SLE in patients with GI involvement.

关键词(KeyWords)： 系统性红斑狼疮;胃肠道;CT;胃肠道功能
systemic lupus erythematosus;gastrointestinal tract;CT;gastrointestinal function

Abstract:

Keywords:

基金项目(Foundation): 国家重点研发项目精准医学专项(2017YFC0909002)

作者(Author): 李皎宇;陈志威;李磊;叶霜;
LI Jiao-yu;CHEN Zhi-wei;LI Lei;YE Shuang;Department of Rheumatology,South Campus,Ren Ji Hospital,School of Medicine,Shanghai Jiaotong University;Department of Radiology,South Campus,Ren Ji Hospital,School of Medicine,Shanghai Jiaotong University;

Email:

DOI:

参考文献(References)：

• [1]Tian XP,Zhang X.Gastrointestinal involvement in systemic lupus erythematosus:Insight into pathogenesis,diagnosis and treatment[J].World J Gastroenterol,2010,16:2971-2977.
• [2]Acar T,Efe D,Yildiz M,et al.Computed tomography angiography(CTA)findings of lupus-associated intestinal vasculitis[J].Eur J Rheumatol,2015,2:45-46.
• [3]Tan TC,Wansaicheong GKL,Thong BYH.Acute onset of systemic lupus erythematosus with extensive gastrointestinal and genitourinary involvement[J].Lupus,2012,21:1240-1243.
• [4]Pardos-Gea J,Ordi-Ros J,Selva A,et al.Chronic intestinal pseudo-obstruction associated with biliary tract dilatation in a patient with systemic lupus erythematosus[J].Lupus,2005,14:328-330.
• [5]Hochberg MC.Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus[J].Arthritis Rheum,1997,40:1725.
• [6]Griffiths B,Mosca M,Gordon C.Assessment of patients with systemic lupus erythematosus and the use of lupus disease activity indices[J].Best Pract Res Clin Rheumatol,2005,19:685-708.
• [7]Reintam BA,Malbrain MLNG,Starkopf J,et al.Gastrointestinal function in intensive care patients:terminology,definitions and management.Recommendations of the ESICMWorking Group on Abdominal Problems[J].Intens Care Med,2012,38:384-394.
• [8]何桂珍.肠道屏障功能与细菌移位[J].协和医学杂志,2012,3:260-264.
• [9]Short V,Herbert G,Perry R,et al.Chewing gum for postoperative recovery of gastrointestinal function[J].Cochrane Dababase Syst Rev,2015,(2):CD006506.
• [10]薛志刚,于健春,康维明,等.围手术期营养干预加速胃肠外科术后康复:单中心前瞻队列研究[J].协和医学杂志,2018,9:526-532.
• [11]Zaghiyan K,Felder S,Ovsepyan G,et al.A Prospective Randomized Controlled Trial of Sugared Chewing Gum on Gastrointestinal Recovery After Major Colorectal Surgery in Patients Managed With Early Enteral Feeding[J].Dis Colon Rectum,2013,56:328-335.
• [12]Vanhauwaert E,Matthys C,Verdonck L,et al.Low-residue and low-fiber diets in gastrointestinal disease management[J].Adv Nutr,2015,6:820-827.
• [13]Si-Hoe CK,Thng CH,Chee SG,et al.Abdominal computed tomography in systemic lupus erythematosus[J].Clin Radiol,1997,52:284-289.
• [14]Ju JH,Min JK,Jung CK,et al.Lupus mesenteric vasculitis can cause acute abdominal pain in patients with SLE[J].Nat Rev Rheumatol,2009,5:273-281.
• [15]都雪朝,薛华丹,何泳蓝,等.自身免疫性胰腺炎患者血清IgG4水平与腹部受累器官CT形态变化的关系[J].协和医学杂志,2016,7:28-32.
• [16]Byun JY,Ha HK,Yu SY,et al.CT features of systemic lupus erythematosus in patients with acute abdominal pain:emphasis on ischemic bowel disease[J].Radiology,1999,211:203-209.
• [17]Buck AC,Serebro LH,Quinet RJ.Subacute abdominal pain requiring hospitalization in a systemic lupus erythematosus patient:a retrospective analysis and review of the literature[J].Lupus,2001,10:491-495.
• [18]de Carvalho JF.Mesenteric Vasculitis in a Systemic Lupus Erythematosus Patient with a Low Sledai:An Uncommon Presentation[J].Clinics,2010,65:337-340.
• [19]Xu N,Zhao J,Liu J,et al.Clinical Analysis of 61 Systemic Lupus Erythematosus Patients With Intestinal Pseudo-Obstruction and/or Ureterohydronephrosis[J].Medicine,2015,94 94:e419.
• [20]Zhang L,Xu D,Yang H,et al.Clinical Features,Mor-bidity,and Risk Factors of Intestinal Pseudo-obstruction in Systemic Lupus Erythematosus:A Retrospective Case-control Study[J]J Rheumatol,2016,43:559-564.
• [21]Janssens P,Arnaud L,Galicier L,et al.Lupus enteritis:from clinical findings to therapeutic management[J].Orphanet J Rare Dis,2013,8:67.
• [22]陈珊宇,徐建华,帅宗文,等.狼疮肠系膜血管炎30例临床分析[J].中华内科杂志,2009,48:136-139.
• [23]Sultan SM,Ioannou Y,Isenberg DA.A review of gastrointestinal manifestations of systemic lupus erythematosus[J].Rheumatology(Oxford,England),1999,38:917-932.
• [24]Helliwell TR,Flook D,Whitworth J,et al.Arteritis and venulitis in systemic lupus erythematosus resulting in massive lower intestinal haemorrhage[J].Histopathology,1985,9:1103-1113.
• [25]Park FD,Lee JK,Madduri GD,et al.Generalized megaviscera of lupus:refractory intestinal pseudo-obstruction,ureterohydronephrosis and megacholedochus[J].World J Gastroenterol,2009,15:3555-3559.
• [26]Chen YQ,Xue Q,Wang NS.Visceral muscle dysmotility syndrome in systemic lupus erythematosus:case report and review of the literature[J].Rheumatol Int,2012,32:1701-1703.