肝硬化患者系统性红斑狼疮1例报告及文献复习

Yangyang Hu, Shaoxian Hu
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摘要

对于失代偿期肝硬化患者,尤其是有乙型肝炎病毒(HBV)感染史、胃肠道出血史和胃底溃疡史的患者,目前尚无系统性红斑狼疮(SLE)的治疗指南。我们医院收治了一位有六年狼疮病史的50岁女性。一个月前,在消化内科,她被诊断为失代偿性肝硬化伴胃底静脉曲张出血和HBV相关感染。在她去医院的过程中,胃镜检查显示食道静脉曲张和一个大的胃底溃疡。实验室数据显示,红细胞、粒细胞和血小板迅速减少,血清球蛋白水平持续升高。根据患者的病史和现有的实验室检查,患者经历了系统性红斑狼疮的恶化,可能危及生命-虽然目前尚不确定肝硬化是由SLE还是HBV感染引起的,但有必要立即治疗。因此,她接受了低剂量甲基强的松龙和霉酚酸酯(MMF)的治疗。该治疗导致了显著的临床改善。此外,没有迹象表明HBV再激活、胃肠道出血、肝功能障碍或其他药物诱导的副作用。该病例表明,无论肝硬化的根本原因如何,低剂量甲基强的松龙和MMF的联合治疗是抑制SLE和失代偿性肝硬化、大胃底溃疡和HBV感染患者疾病进程的有效治疗方法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Systemic Lupus Erythematosus in a Patient with Liver Cirrhosis: Case Report and Literature Review
There are no treatment guidelines for systemic lupus erythematosus (SLE) for the patients with decompensated cirrhosis, especially for those who have a history of hepatitis B virus (HBV) infection, gastrointestinal bleeding and gastric fundus ulceration. A 50-year-old woman who had a six-year history of lupus was admitted to our hospital. One month prior, at the Department of Gastroenterology, she was diagnosed with decompensated liver cirrhosis with gastric fundal varicose bleeding, and HBV-related infection. During her visit to the hospital, gastroscopy showed esophageal varices and a large gastric fundus ulcer. Laboratory data indicated the rapid decrease of red blood cells, granulocytes and platelets and the persistent increase of serum globulin levels. According to the patient's medical history and existing laboratory examination, the patient experienced an exacerbation of SLE, which could be life-threatening.-While it remained uncertain whether the liver cirrhosis was caused by SLE or the HBV infection, immediate treatment was necessary. Consequently, she was treated with a low dose of methylprednisolone and mycophenolate mofetil (MMF). The treatment resulted in significant clinical improvement. Moreover, there was no indication of HBV reactivation, gastrointestinal bleeding, liver dysfunction or other drug-induced side effects. This case indicated that irrespective of the underlying causes of liver cirrhosis, the combination of a low dose of methylprednisolone and MMF is an effective treatment method to inhibit the disease process for patients with SLE and decompensated liver cirrhosis, a large gastric fundus ulcer and HBV infection.
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