全身性紅斑性狼瘡以急性胰臟炎為最初臨床表現－－病例報告

Acute Pancreatitis as an Initial Presentation in Systemic Lupus Erythematosus-- a Case Report

全身性紅斑性狼瘡併發急性胰臟炎在臨床醫學報告上實屬罕見，尤其是以急性胰臟炎作為最初臨床表現，在文獻上只有少數病例被提出。吾人報告一位39歲女性患者因發燒及腹痛住進羅東博愛醫院內科，經診斷證實為全身性紅斑性狼瘡併發急性胰臟炎。腹部超音波顯示為急性胰臟炎且血清澱粉酶濃度高達5260U/L。病人先前未曾服用類固醇，利尿劑或免疫抑制劑，也沒有喝酒或膽道結石病史。最後病人死於成人呼吸窘迫症侯群併發症。有關全身性紅斑性狼瘡併發胰臟炎的機轉目前尚未定論，值得一提的是本病患有高濃度血清抗牛心脂質抗體，吾人推斷此種抗體在全身性紅斑性狼瘡併發急性胰臟炎可能扮演重要角色，其相關機轉將於文中一併討論。

The manifestation of acute pancreatitis in systemic lupus erythematosus is quite uncommon. We report a 39-year-old female lupus patient with initial presentation of acute pancreatitis confirmed by diffuse enlarged pancreas on abdominal ultrasonography and elevated total serum amylase. The patient died due to the complication of adult respiratory distress syndrome (ARDS). The mechanism of acute pancreatitis complicating systemic lupus erythematosus is still controversial. Highly elevated anticardiolipin autoantibodies are found in this patient, which may also play an important role in pancreatitis related to systemic lupus erythematosus. The possible pathophysiological correlation is discussed in this report.