紅斑性狼瘡病人合併腸胃道血管炎與無合併腸胃道血管炎之臨床表徵和BILAG疾病活動性指數之比較

Comparison of clinical manifestations and BILAG disease activity index in systemic lupus erythematosus patients with and without gastrointestinal vasculitis

目的：研究紅斑狼瘡病人合併腸胃道血管炎的臨床徵象及BILAG疾病活動性。方法：回溯性地研究自西元2000年1月至2008年5月間因血管炎診斷而入院的紅斑狼瘡病人。依據病人的臨床症狀和腹部電腦斷層的結果來確定腸胃道血管炎的診斷，共有42位病人計61次入院在病歷的檢閱中被確定為腸胃道血管炎（A組），另外有21位經腹部電腦斷層確定非腸胃道血管炎而有腸胃道症狀的病人被納入為對照組（B組）。結果：A組病人平均年齡及發病時間分別為27.6歲及5.6年。57.4%的A組病人在入院中出現腹部反彈痛。比較兩組病人的基本資料、臨床表徵、自體抗體及其他血清檢驗皆無顯著差異。唯一有顯著差異的是合併腸胃道血管炎的狼瘡病人在研究時具有較高的BILAG總分。結論：在疾病處於活動期的紅斑狼瘡病人出現急性腹部疼痛時應該要考慮合併腸胃道血管炎。除了BILAG總分外其他BILAG各單項及臨床表徵皆無法分辨狼瘡病人是否合併腸胃道血管炎。

Objective: To investigate the clinical features and British Isles Lupus Assessment Group index (BILAG) in systemic lupus erythematosus (SLE) patients with gastrointestinal vasculitis. Methods: A retrospective study was conducted in SLE patients admitted to our hospital due to gastrointestinal manifestations from January 2000 to May 2008. The diagnosis of gastrointestinal vasculitis was made by clinical features and abdominal CT scan findings. Chart reviews identified 42 patients with a total of 61 admissions for gastrointestinal vasculitis (group A). Another 21 patients without gastrointestinal vasculitis, which was confirmed by abdominal CT scans, were enrolled as the control group (group B). Results: The mean age and disease duration in group A were 27.6 years and 5.6 years respectively. Rebound tenderness of the abdomen in group A was found in 57.4% of admissions. There were no significant differences in the demographic data, clinical features, autoantibody profiles and other serologic parameters between SLE patients in the two groups. However, SLE patients in group A had higher BILAG global score at the time of investigation. Conclusion: Gastrointestinal vasculitis is a common cause of abdominal pain in patients with active SLE. Except BILAG global score, the common clinical manifestations and BILAG components do not correlate with the occurrence of gastrointestinal vasculitis in lupus patients.