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Chief Complaints of Patients with Systemic Lupus Erythematosus Admitted to Emergency Department
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摘要:
目的 总结急诊就诊的系统性红斑狼疮(systemic lupus erythematosus, SLE)患者的主诉症状及特点。 方法 采用回顾性分析的方法对本院急诊科2009年9月至2013年1月留观的200例SLE患者主诉症状数目、常见症状分布、初治患者主诉症状分布、发热的病因等方面情况进行统计分析。 结果 SLE患者急诊就诊时主诉症状以两种症状为多见(47.5%, 95/200), 发热是最常见症状(58%, 116/200);中枢神经系统(38.5%, 20/52)、呼吸系统(23.1%, 12/52)和消化系统(19.2%, 10/52)受累易伴发热; 初治SLE患者发热病因多为狼疮活动(78.8%, 26/33), 非初治SLE患者发热病因多为继发感染(69.9%, 58/83);感染性发热患者最常见的感染部位为肺部(81.5%, 53/65)。 结论 急诊就诊的SLE患者主诉症状有一定的特点, 了解其规律可最大程度避免误诊和漏诊。 Abstract:Objective To analyze the chief complaints of patients with systemic lupus erythematosus (SLE) presenting to emergency department (ED). Methods The chief complaints of 200 patients with SLE who admitted to the ED in our hospital from September 2009 to January 2013 were retrospectively analyzed. Clinical data queried included:the number and distribution of chief complaint symptoms, the chief complaint symptoms of the untreated patients with SLE, and the causes of fever. Results Two different symptoms were most commonly reported at presentation to the ED (47.5%, 95/200), with fever being the most common (58%, 116/200). Other common symptoms involved the central nervous system (38.5%, 20/52), respiratory system (23.1%, 12/52), and digestive system (19.2%, 10/52) were prone to be complicated with fever. The most common cause of fever was lupus activity in untreated patients with SLE (78.8%, 26/33) and infection in patients with SLE exacerbation (69.9%, 58/83). In patients with infection-induced fever, the most common location of infection was respiratory system (81.5%, 53/65). Conclusion SLE patients admintted to ED have a variety of chief complaints, which should be carefully distinguished for particular features during the diagnosis. -
表 1 SLE患者急诊就诊时主诉症状分布[例(%)]
症状 单一主诉
症状主诉症状为单一
系统受累伴发热初治SLE患者
主诉症状发热 19(36.5)* — 33(66)* 中枢系统症状 10(19.2) 20(38.5) 15(30) 血液系统症状 10(19.2) 2(3.8) 6(12) 呼吸系统症状 5(9.6) 12(23.1) 5(10) 消化系统症状 3(5.8) 10(19.2) 11(22) 泌尿系统症状 4(7.7) 2(3.8) 8(16) 循环系统症状 1(1.9) 2(3.8) 7(14) 关节肌肉症状 0 3(5.8) 9(18) 皮肤症状 0 1(1.9) 6(12) SLE：系统性红斑狼疮；与其他各系统比较，*P＜0.05 
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表 2 感染性发热患者病因分布
病原学 例(%) 病毒 巨细胞病毒 22(33.8) 带状疱疹病毒 4(6.2) EB病毒 1(1.5) 未知 1(1.5) 真菌 隐球菌 5(7.7) 念珠菌 7(10.8) 曲霉菌 3(4.6) 未知 4(6.2) 细菌 革兰阳性菌 8(12.3) 革兰阴性菌 11(16.9) 结核杆菌 2(3.1) 卡式肺孢子虫 4(6.2) 衣原体 1(1.5)
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[1] Hochberg MC. Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus[J].Arthritis Rheum, 1997, 40:1725. https://pubmed.ncbi.nlm.nih.gov/9324032/ [2] 何伟珍, 叶志中, 尹志华, 等.系统性红斑狼疮伴发热的病情活动与感染的鉴别[J].实用医学杂志, 2008:3674-3676. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=syyxzz200821019 [3] 李志军, 王涛, 杨珂珂, 等.系统性红斑狼疮患者医院感染的特点及其危险因素分析[J].中华医院感染学杂志, 2009:43-46. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zhyygrxzz200903011 [4] Bouza E, Moya JG, Munoz P. Infections in systemic lupus erythematosus and rheumatiod arthritis[J]. Infect Dis Clin North Am, 2001, 15:335-361. doi: 10.1016/S0891-5520(05)70149-5 -
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