Analysis Of Clinical Cases Of Systemic Lupus Erythematosus Complicated With Mesenteric Vasculitis And/or Renal Pelvic Ureteral Dilatation

Objective:To explore the clinical characteristics,treatment and prognosis of Systemic lupus erythematosus(SLE)with rare complications of Mesenteric vasculitis(MV)and / or Ureterohydronephrosis(UH),aiming to improve the doctor's Combining the understanding of MV and UH has attracted the attention of doctors to reduce the rate of missed diagnosis and misdiagnosis,thereby avoiding the serious consequences of delaying the disease and providing clinical guidance for the treatment and prognosis evaluation of the disease Subjects and Methods:To retrospectively investigate the clinical case data of SLE patients(ie,research groups)with MV and / or UH who were hospitalized in the Affiliated Hospital of Qingdao University from 2013 to 2019,and record the system involvement,laboratory test results,and treatment plan As well as prognosis,each patient is evaluated according to the SLEDAI scoring criteria to obtain the SLEDAI score.During the same period,100 SLE patients without MV and UH were randomly selected from the hospitalized SLE patients in the Department of Rheumatology and Immunology of the Affiliated Hospital of Qingdao University as the control.Each patient is evaluated to obtain the SLEDAI score.The study group and the control group were compared in terms of systematic involvement of the disease,laboratory examination,SLEDAI score,treatment plan,and disease prognosis,and the study group patients were divided into three groups,namely,SLE combined with MV and UH patient group,SLE only merged with MV patient group and SLE only combined with UH patient group.The descriptive analysis was also conducted on the three groups of patients from the characteristics of systemic involvement of the disease,laboratory examination,SLEDAI score,treatment plan and disease prognosis.Results:1.A total of 31 patients in the study group had an average age of onset at the time of diagnosis of SLE of 35.90±14.50 years,ranging from 13 to 61 years.The study group was all female.A total of 100 patients in the control group were diagnosed with SLE.The average age at onset was 36.80±13.80 years,including 95 women and 5 men.There was no statistically significant difference in the age and sex of the first episode of SLE between the two groups.2.Statistical analysis shows that there is a correlation between SLE-related MV and UH.3.Among the patients in the study group,29.03%(9 patients)had MV as the first manifestation;32.26%(10 patients)had UH at the time of the first diagnosis of SLE,5 of them had UH-related symptoms,and 5 cases were found through auxiliary examination;22.58% of patients(7 cases)had both MV and UH at the time of the initial diagnosis of SLE.As of December 31,2019,74.19%(23 cases)of the patients in the study group had improved after treatment,and the condition was relieved and in a stable state.,22.58%(7 cases)of patients had repeated attacks,and 3.23%(1 case)of patients died of recurrent lupus encephalopathy and pancreatitis.4.The incidence of fever,kidney involvement,heart involvement and serositis in the study group was significantly higher than that in the control group.5.The incidence of ESR increased,IgG increased,dsDNA positive,anti-SSA positive and anti-SSB positive in the study group was significantly higher than that in the control group.6.The study group had a higher SLEDAI score than the control group.58.10% of the patients in the study group had a SLEDAI score ?15(severe lupus),and 20.00% of the patients in the control group had a SLEDAI score ?15.7.The amount of glucocorticoid used in the study group was 142.26±170.85mg/d,and the amount of glucocorticoid used in the control group was 74.95±156.31mg/d.The amount of hormone used in the study group was significantly higher than that in the control group.All patients in the study group were initially treated with medium to high-dose glucocorticoid GC.25.81%(8 patients)of the study group received 3-5 days of methylprednisolone shock therapy,96.77%(30 patients)responded well to the treatment,of which 1 patient died of repeated pancreatitis and lupus encephalopathy,1 patient with UH developed hemorrhagic cystitis,and 1 patient with SLE combined with UH eventually underwent bilateral ureteral catheterization.There is no significant difference in the use of immunosuppressants and immunoglobulins.8.The prognosis(improvement,recurrence,and death)of the two groups of patients were significantly different.The incidence of recurrent illness and death outcomes in the study group was higher than that in the control group.Conclusion and significance:MV and UH are rare but serious complications of SLE.There is no significant difference in age and gender between the study group and the control group,indicating that gender and age are not risk factors for SLE combined with MV and UH.The incidence of fever,kidney involvement,cardiac involvement,and serositis in the study group was significantly higher than that in the control group,suggesting that routine diagnosis of urine or protein in urine may be helpful in the diagnosis of SLE when diagnosing MV or UH of unknown cause MV and UH,and pay attention to the heart and organs with serous cavity.The incidence of dsDNA positive,anti-SSA positive and anti-SSA positive in the study group was significantly higher than that in the control group.The three antibodies may play a role in the pathogenesis of two complications.The specific mechanism of action cannot be inferred by this study.The study group had a higher SLEDAI score than the control group,and was significantly higher than the control group in terms of increased ESR and IgG incidence,indicating that SLE with MV and / or UH is in a more serious disease state and needs to cause more attention.With regard to the choice of treatment plan,the patients in the study group all adopted the treatment plan of glucocorticoid combined with immunosuppressive agents,and usually responded well to the best early glucocorticoid treatment..In terms of prognosis,the prognosis of the study group is worse than that of the control group,which again shows that MV and UH are serious complications of SLE.The significance of this research is that the combined MV and UH of SLE involve multiple professional fields,such as rheumatology and immunology,gastroenterology,urology,etc.Through this research,clinicians in related professional fields can fully understand and value these rare concurrency of SLE On the one hand,it can promote rapid and accurate diagnosis,reduce the risk of misdiagnosis and missed diagnosis,and avoid delayed treatment;on the other hand,it can quickly start appropriate treatment to control the disease as soon as possible,avoid unnecessary irreversible organ damage,and improve prognosis.