中文摘要：

目的 探讨SLE肠系膜血管炎（LMV）患者的临床表现、实验室检查等方面的特点.方法 总结2009年10月至2012年1月于我院风湿免疫科确诊为LMV的36例患者的临床资料,并和72例非LMV的SLE患者（1∶2）进行回顾性对比分析.分类资料采用四格表x2检验,定量资料采用Z检验或t检验.结果 ①3 051例SLE患者中有36例LMV,发病率1.2％,以LMV为首发表现的有4.7％（17例）.LMV患者全为女性,与对照组比较差异有统计学意义.胃肠道表现为腹痛78％（28例）,恶心或呕吐58％（21例）、腹胀50％（18例）、腹泻47％（17例）,发生肠穿孔3％（1例）,不完全肠梗阻8％（3例）,无完全肠梗阻;②81％LMV患者的腹部增强CT显示肠管肿胀扩张和（或）肠系膜增厚水肿;根据SLEDAI评分,SLE高度活动67％（24例）、中度活动28％（10例）、轻度活动6％（2例）,平均SLEDAI为（17±5）分,非LMV SLE组相比,差异有统计学意义（Z=4.30,P＜0.05）;LMV组平均补体C3为（0.44±0.25） g/L,平均补体C4为（0.10±0.09） g/L,与非LMV SLE患者相比,差异具有统计学意义（Z值分别为-3.58和-2.94,P值均＜0.05）;LMV患者的抗体谱与非LMV SLE组差异无统计学意义;LMV患者抗心磷脂抗体（ACA）阳性率为20％（5例）;36％（13例）患者合并SLE肾炎,3％（1例）患者合并SLE脑病;③61％（22例）LMV患者经过大剂量甲泼尼龙治疗（≥200 mg/d,3～5 d）腹痛好转或缓解.预后：死亡3％（1例）,手术8％（3例）.结论 ①女性SLE患者可能更易合并LMV;腹痛为主要临床表现,多为脐周压痛;部分患者以LMV为首发表现易误诊,延迟确诊;②腹部增强CT对LMV的诊断具有重要意义;③LMV常合并SLE肾炎;④LMV大多在SLE活动时发生,补体C3、C4中度降低;⑤大部分患者需要大激素冲击治疗,每月环磷酰胺冲击,疗效好.

英文摘要：

Objective To analyze the clinical profiles of lupus mesenteric vasculitis （LMV）.Methods Thirty-six SLE patients diagnosed with LMV and 72 SLE patients （1：2） without LMV at West China Hospital between October 2009 and January 2012 were enrolled.The imaging,clinical manifestation,laboratory examinations data were analyzed retrospectively.Quantitative differences were analyzed by the Student＇s t and Z tests and qualitative data were compared with Chi-square.P value less than 0.05 was considered as statistically significant.Results ① The prevalence of LMV in patients with SLE was 1.2%（36/3 051）,while 47%（17/36） as the initial symptom of SLE.Thirty-six LMV patients were all female.The prevalence of abdominal pain was 78%（28/36）,nausea or vomitting was 58%（21/36）,abdominal distension was 50%（18/36）,diarrhea was 47.2% （17/36）,intestinal perforation was 3% （1/36） and incomplete obstruction was 8% （3/36）.Enhanced CT scan showed 81%（25/31） patients suffered from intestinal dilation and （or） mesenteric edema;SLEDAI （17±5）,C3 （0.44±0.25） g/L,C4 （0.10±0.09） g/L,Z value on above items were 4.30,-3.85 and-2.94 respectively compared to SLE patients without LMV,and all P〈0.05,the differemces were significant.In addition,Also,the proportion of ANA and anti-ENA antibody showed no significant difference.68.6%（13/36） patients were also diagnosed with lupus nephritis;61%（22/36） patients were treated with methylprednisolone more than 200 mg/d resulting in relief of symptom.Conclusion Female patients with SLE may be more likely to suffer from LMV;Enhanced abdominal CT scan is still essential to the diagnosis of LMV.LMV is correlated with urinary system malfunction.LMV always occurs in active lupus with low C3 and C4 level.More than half patients should be treated with corticosteroid and cyclophosphamide pulse therapy.