中国实用儿科杂志

中国实用儿科杂志 ›› 2011, Vol. 26 ›› Issue (9): 702-.

• 论著 • 上一篇    下一篇

系统性红斑狼疮并发乳糜性腹水1例报道并文献复习

  

  1. 中山大学附属第一医院，广州　510080
  • 出版日期:2011-09-06 发布日期:2011-10-12

Chylous ascites associated with systemic lupus erythematosus（SLE） in a child：a case report and review of literature.

  1. Department of Pediatrics，the First Affiliated Hospital of Sun Yat-Sen University，Guangzhou，510080，China
  • Online:2011-09-06 Published:2011-10-12

摘要：

摘要：目的　总结对系统性红斑狼疮（SLE）并发乳糜性腹水的诊断及治疗经验。方法　报道中山大学附属第一医院儿科首例SLE并发乳糜性腹水患儿的诊治经过并进行文献复习。结果　患儿诊断为SLE、狼疮性肾炎（LN）、溶血性贫血。LN表现为肾病综合征型，肾穿刺活检示LN V+III（A/C），伴有持续严重腹水，腹水检查提示为乳糜性腹水，先后给予甲泼尼龙（MP）、环磷酰胺（CTX）冲击及饮食治疗，狼疮指标好转，腹水消退。查阅相关文献，其发病机制可能与SLE对淋巴网状系统的影响，低蛋白血症致肠壁水肿，淋巴管通透性增加，脂质代谢异常等因素有关。结论　SLE并发乳糜性腹水属罕见病例，对SLE合并难治性腹水，建议行腹腔穿刺腹水检查排除乳糜腹。治疗原则是以原发病变的治疗为主，配合饮食控制等保守治疗。

关键词: 系统性红斑狼疮, 狼疮性肾炎, 乳糜性腹水, 儿童

Abstract:

Abstract：Objective　To improve the recognition and treatment of chylous ascites associated with systemic lupus erythematosus （SLE）. Methods　Report a case of chylous ascites as a complication of SLE in a child and review the related literature. Results　The patient was diagnosed with SLE，lupus nephritis（LN） and hemolytic anemia. The LN showed nephrotic syndrome，and renal biopsy suggested LN V+III（A/C）. The patient had persistent severe ascites which was examined to be chylous ascites. After being treated with high dose of Methylprednisolone（MP） and Cyclophosphamide（CTX） and diet therapy，the index of lupus was improved and ascites regressed. According to relevant literature，the mechanisms of chylous ascites may be associated with SLE’s impacting on the lymphoreticular system，bowel edema which was induced by hypoproteinemia，increasing permeability of lymphatic vessels，abnormal lipid metabolism and so on. Conclusion　Chylous ascites is a rare complication of SLE. Abdominal paracentesis is suggested to exclude chylous ascites when SLE is complicated with refractory ascites. The treatment principle of this illness is to cure primary disease，combined with conservative treatment such as diet control，etc.

Key words: systemic lupus erythematosus, lupus nephritis, chylous ascites, children