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病例讨论:SLE伴反复呕吐、腹胀、肾积水

2010-09-12 MedSci原创 MedSci原创

SLE呕吐肾积水腹胀
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来源：中国医学论坛报 作者：南京军区南京总医院 张炯 章海涛 刘志红 　　病历摘要 　　患者女，16岁，因“确诊系统性红斑狼疮（SLE）6个月，反复腹泻、呕吐4个月，加重3天”入院。患者因先后出现眼睑及下肢水肿、尿蛋白和尿隐血、多个关节疼痛、血常规三系减少等，于6个月前来我科就诊，并被诊为SLE。其中，SLE疾病活动性指数（SLE-DAI）为11分，肾活检示狼疮性肾炎Ⅳ型[活动性指数（AI）

来源：中国医学论坛报 作者：南京军区南京总医院 张炯 章海涛 刘志红 　　病历摘要 　　患者女，16岁，因“确诊系统性红斑狼疮（SLE）6个月，反复腹泻、呕吐4个月，加重3天”入院。患者因先后出现眼睑及下肢水肿、尿蛋白和尿隐血、多个关节疼痛、血常规三系减少等，于6个月前来我科就诊，并被诊为SLE。其中，SLE疾病活动性指数（SLE-DAI）为11分，肾活检示狼疮性肾炎Ⅳ型[活动性指数（AI）6分，慢性指数（CI）0分]。在0.5 g/d甲泼尼龙冲击3天后，患者继续接受30 mg/d泼尼松和0.75 g/d吗替麦考酚酯治疗；后因抽血处感染而停用吗替麦考酚酯，泼尼松减至15 mg/d，口服抗生素后好转出院。 　　4个月前，患者无明显诱因出现上腹痛伴发热，无腹泻、呕吐，体温最高为39℃，第二次入住我科。检查结果示，肝酶升高、自身免疫性肝病相关抗体阴性。住院期间，患者出现腹胀、腹泻（黄色水样便），大便常规及细菌培养无异常；每天排尿10～15次，双肾B超提示肾盂、上段输尿管积水，膀胱残余尿量约84 ml。患者接受抗感染、止泻等对症治疗，泼尼松增至45 mg/d，消化道症状好转。磁共振成像（M

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    2011-05-04 yxch36

    #病例讨论#

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=1986270, encodeId=fc4219862e033, content=<a href='/topic/show?id=7454e07856a' target=_blank style='color:#2F92EE;'>#病例讨论#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=70785, encryptionId=7454e07856a, topicName=病例讨论)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4cea26, createdName=yxch36, createdTime=Wed May 04 20:28:00 CST 2011, time=2011-05-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1931815, encodeId=e8011931815df, content=<a href='/topic/show?id=f6148261857' target=_blank style='color:#2F92EE;'>#肾积水#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82618, encryptionId=f6148261857, topicName=肾积水)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b505306, createdName=医生2394, createdTime=Fri Jul 08 05:28:00 CST 2011, time=2011-07-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1313282, encodeId=66ae1313282fa, content=<a href='/topic/show?id=697a85583cf' target=_blank style='color:#2F92EE;'>#腹胀#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=85583, encryptionId=697a85583cf, topicName=腹胀)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d64f419, createdName=qindq, createdTime=Tue Sep 14 13:28:00 CST 2010, time=2010-09-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1344865, encodeId=f922134486574, content=<a href='/topic/show?id=cf721640495' target=_blank style='color:#2F92EE;'>#SLE#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16404, encryptionId=cf721640495, topicName=SLE)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/kbRUeosenzlejlNGWXdWjSYhBKL1QYGQwfehJOkMXHiavh5wl7pKeju5Kcxdvr50ic6FWML3x6NMCxhG1bOaVjyA/132, createdBy=20872500216, createdName=ms4657536712156177, createdTime=Tue Sep 14 13:28:00 CST 2010, time=2010-09-14, status=1, ipAttribution=)]
    2011-07-08 医生2394

    #肾积水#

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=1986270, encodeId=fc4219862e033, content=<a href='/topic/show?id=7454e07856a' target=_blank style='color:#2F92EE;'>#病例讨论#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=70785, encryptionId=7454e07856a, topicName=病例讨论)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4cea26, createdName=yxch36, createdTime=Wed May 04 20:28:00 CST 2011, time=2011-05-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1931815, encodeId=e8011931815df, content=<a href='/topic/show?id=f6148261857' target=_blank style='color:#2F92EE;'>#肾积水#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82618, encryptionId=f6148261857, topicName=肾积水)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b505306, createdName=医生2394, createdTime=Fri Jul 08 05:28:00 CST 2011, time=2011-07-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1313282, encodeId=66ae1313282fa, content=<a href='/topic/show?id=697a85583cf' target=_blank style='color:#2F92EE;'>#腹胀#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=85583, encryptionId=697a85583cf, topicName=腹胀)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d64f419, createdName=qindq, createdTime=Tue Sep 14 13:28:00 CST 2010, time=2010-09-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1344865, encodeId=f922134486574, content=<a href='/topic/show?id=cf721640495' target=_blank style='color:#2F92EE;'>#SLE#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16404, encryptionId=cf721640495, topicName=SLE)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/kbRUeosenzlejlNGWXdWjSYhBKL1QYGQwfehJOkMXHiavh5wl7pKeju5Kcxdvr50ic6FWML3x6NMCxhG1bOaVjyA/132, createdBy=20872500216, createdName=ms4657536712156177, createdTime=Tue Sep 14 13:28:00 CST 2010, time=2010-09-14, status=1, ipAttribution=)]
    2010-09-14 qindq

    #腹胀#

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=1986270, encodeId=fc4219862e033, content=<a href='/topic/show?id=7454e07856a' target=_blank style='color:#2F92EE;'>#病例讨论#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=70785, encryptionId=7454e07856a, topicName=病例讨论)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4cea26, createdName=yxch36, createdTime=Wed May 04 20:28:00 CST 2011, time=2011-05-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1931815, encodeId=e8011931815df, content=<a href='/topic/show?id=f6148261857' target=_blank style='color:#2F92EE;'>#肾积水#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82618, encryptionId=f6148261857, topicName=肾积水)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b505306, createdName=医生2394, createdTime=Fri Jul 08 05:28:00 CST 2011, time=2011-07-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1313282, encodeId=66ae1313282fa, content=<a href='/topic/show?id=697a85583cf' target=_blank style='color:#2F92EE;'>#腹胀#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=85583, encryptionId=697a85583cf, topicName=腹胀)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d64f419, createdName=qindq, createdTime=Tue Sep 14 13:28:00 CST 2010, time=2010-09-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1344865, encodeId=f922134486574, content=<a href='/topic/show?id=cf721640495' target=_blank style='color:#2F92EE;'>#SLE#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16404, encryptionId=cf721640495, topicName=SLE)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/kbRUeosenzlejlNGWXdWjSYhBKL1QYGQwfehJOkMXHiavh5wl7pKeju5Kcxdvr50ic6FWML3x6NMCxhG1bOaVjyA/132, createdBy=20872500216, createdName=ms4657536712156177, createdTime=Tue Sep 14 13:28:00 CST 2010, time=2010-09-14, status=1, ipAttribution=)]
    2010-09-14 ms4657536712156177

    #SLE#

    0