由影像定義的狼瘡性腸繫膜血管炎在臨床及電腦斷層上的表現

Clinical and abdominal computerized tomography characteristics of patients with image-defined lupus mesenteric vasculitis

目的：狼瘡性腸繫膜血管炎（LMV）在紅斑性狼瘡（SLE）患者急性腹痛的鑑別中，是一項罕見但具挑戰性的診斷。本研究目的即是探討本院LMV患者在臨床上和電腦斷層的特徵，並且進一步和對照組比較，以期能找出LMV發作的危險因子。方法：我們收錄高雄長庚醫院自2004年至2012年間，共17例SLE住院患者。所有患者皆出現腹痛，並且在腹部電腦斷層（CT）掃描至少出現下列三個以上的影像徵象：腸壁增厚、腸道擴張、標靶徵象、梳狀徵象、脂肪強度衰減或霧化。我們紀錄各患者的臨床症狀，實驗室數據和治療結果。對照組則為25例曾經歷急性腹痛而來急診的SLE病患，皆接受過CT檢查沒有上述所提及的影像特色，並且排除為LMV。結果：在17例患者中，最常見的臨床症狀為腹痛，噁心嘔吐和腹瀉。常見的腹部CT表現主要是腸壁增厚、腸道擴張、梳狀徵象。在實驗室檢查的部分，血液相、C-反應蛋白、anti-double stranded DNA、補體在LMV發病前後二者並無顯著性差異。然而抗磷脂抗體（anti-β2 glycoprotein I）在實驗組中則有較高的比例（OR = 6.33, 95% CI = 1.06-37.78, p=0.04）。結論：狼瘡性腸繫膜血管炎患者無論在臨床症狀或是電腦斷層上有其臨床特色，在SLE急性腹痛的病人中，抗磷脂抗體anti-β2 glycoprotein I可能是預測LMV發作的危險因子之一。

Objective: Lupus mesenteric vasculitis (LMV) is a rare but challenging diagnostic issue related to patients with systemic lupus erythematosus (SLE). Early recognition by means of clinical signs, laboratory parameters and abdominal computerized tomography (CT) can help in differential diagnosis. The aim of this study was to describe the clinical characteristics, images features and discover possible risk factors of patients with LMV. Methods: Seventeen patients with history of SLE at Kaohsiung Chang Gung Memorial Hospital from 2004 to 2012 were identified according to clinical symptoms and fulfilling at least three of the following signs on abdominal CT scan: bowel wall thickening, bowel distention, target sign, comb sign, and fat attenuation. We recorded the clinical symptoms, laboratory data, and compared with 22 control lupus patients who experienced abdominal pain but LMV was excluded after abdominal CT survey. Results: The most frequent clinical symptoms of the 17 patients were abdominal pain, nausea/vomiting, and diarrhea. The abdominal CT findings were mainly bowel wall thickening, bowel distention and the comb sign. There were no significant differences between baseline and LMV onset in the hemogram, C-reactive protein, complement, and anti-double stranded DNA antibody. Patients with positive anti-β2 glycoprotein I antibody had a greater tendency to develop LMV than the control group (OR = 6.33, 95% CI = 1.06-37.78, p=0.04). Conclusions: We identified the frequent clinical symptoms and abdominal CT features present in patients with LMV. Of all the laboratory parameters and serologic markers, anti-β2 glycoprotein I antibody was found to be a risk factor that is associated with LMV.