A Study Of Clinical Manifestations Of Systemic Lupus Erythematosus With Extrarenal Visceral Vasculitis

Objective: To investigate the clinical manifestations of systemic lupus erythematosus associated with extrarenal visceral vasculitis,and to analyze the differences in laboratory parameters and the characteristics of imaging performance and renal pathology.Methods: Collected the clinical materials of patients with lupus extrarenal visceral vasculitis and patients with systemic lupus erythematosus without extrarenal visceral vasculitis hospitalized in the first affiliated hospital of Guangxi Medical University from October 2012 to October 2016.Retrospective studied the clinical manifestations,imaging changes,renal pathological features,treatment methods,and prognosis of patients with extrarenal visceral vasculitis.Results:1.In this study,2926 patients with systemic lupus erythematosus were collected,of which 46(1.57%)had extrarenal visceral vasculitis.2.In this retrospective analysis,the clinical types of extrarenal visceral vasculitis: lupus mesenteric vasculitis,diffuse alveolar hemorrhage,ocularvasculitis,and central nervous system vasculitis.Among them,lupus mesenteric vasculitis is the most in common(56.52%).3.There were 46 cases of SLE extrarenal vasculitis in total,including 2males and 44 females,and the ratio of male to female is 1:22.00;There were2880 cases of SLE without extrarenal vasculitiss,including 405 males and 2475 females,with a ratio of 1:6.11.The statistical analysis of SLE patients with extrarenal visceral vasculitis and without extralrenal visceral vasculitis were performed,P=0.059,the difference was not statistically significant.4.There were 37 cases(80.43%)diagnosed with lupus nephritis in the group with extrarenal visceral vasculitis,and 1639 cases(56.91%)diagnosed with lupus nephritis in the group without extrarenal visceral vasculitis.The incidence rate of renal injury in patients with SLE combined with extrarenal vasculitis was higher than that in SLE without extrarenal vasculitis group,P=0.001,the difference is statistically significant.5.Among the 46 cases with extrarenal vasculitis,19 cases underwent renal biopsy.The pathological types were more common in type III(n=4),type IV(n=4),and type V+III(n=5).Under light microscope,there were 5 cases(26.32%)with crescent formation and 5 cases(26.32%)with fibrinoid necrosis.6.Among the 26 cases of SLE with lupus mesenteric vasculitis,the most common symptoms were abdominal pain(76.92%),followed by nausea(57.69%)and diarrhea(53.85%).7.All 11 patients with SLE combined diffuse alveolar hemorrhage had cough(100%)and hypoxemia(100%).Most patients had clinical symptoms of hemoptysis(81.82%)and dyspnea(90.91%).8.Among the 11 patients with diffuse pulmonary alveolar hemorrhage complicated with SLE,10 patients underwent CT examination of the lungs: 10patients(100%)with newly developed diffuselarge-chip,frosted and glassyplaque on chest CT.Conclusion:1.Lupus mesenteric vasculitis is the most common type of extrarenal visceral vasculitis of systemic lupus erythematosus.2.Systemic lupus erythematosus with extrarenal visceral vasculitis has a high incidence of renal injure,so kidney puncture should be done as soon as possible.3.Abdominal pain is the most common clinical manifestation of lupus mesenteric vasculitis.4.Cough and Hypoxemia are the Most Common Clinical Symptoms of SLE with Diffuse Alveolar Hemorrhage.5.The chest CT examination of patients with diffuse alveolar hemorrhage all indicated new diffuse or patchy shadows.