胸膜粘连术治疗系统性红斑狼疮合并难治性胸腔积液并文献复习
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摘要
目的探讨胸膜粘连术(pleurodesis)应用于系统性红斑狼疮(systemic lupus erythematosus,SLE)合并难治性胸腔积液的临床疗效。方法回顾性分析北京世纪坛医院诊治的4例经胸膜粘连术治疗的SLE合并难治性胸腔积液患者的临床资料,并复习国内外相关文献。结果该院4例患者均为女性,SLEDAI评分显示病情稳定,唯胸腔积液持续,3例双侧,1例局限在左侧,有1例为乳糜性胸腔积液。国内外文献查阅到资料相对完整的病例7例,其中6例女性,1例男性;双侧胸腔积液3例,左侧2例,右侧2例;积液性质均为渗出性。11例患者因顽固性胸腔积液均接受过大剂量糖皮质激素及联用包括环磷酰胺、硫唑嘌呤等多种免疫抑制剂的治疗,但仍需反复抽取积液,其中1例患者术前抽取胸腔积液总量>80 L。国内该院4例行胸膜粘连手术,术中患者耐受性良好,术后无并发症,随诊2~8年未出现胸腔积液复发。文献中的7例患者术后亦未出现病情复发。结论 SLE合并难治性胸腔积液临床罕见,药物治疗效果差,传统的胸膜粘连术能有效改善患者预后及生存质量。
Objective To investigate the effect and feasibility of pleurodesis in the treatment of systemic lupus erythematosus(SLE) complicated with refractory pleural effusion. Methods The clinical data on four patients were diagnosed with SLE complicated with refractory pleural effusion and received pleurodesis was retrospectively analyzed. At the same time,using such terms as " lupus" and " pleural effusion",we searched English literature in Pubmed and in WanFang Database of China. Results A total of 7 cases with relative complete data were found from the literature. Six patients were female,and one was male. Three cases had bilateral pleural effusion,two had left pleural effusion,and two had right pleural effusion. Then,these eleven patients were analyed together. Those patients who suffered significant dyspnea were related to chronic pleural effusion. They were all treated with a large dose of corticosteroid and immunosuppressive agents before pleurodesis,but none of the therapies was valid. They had undergone frequent multiple fluid aspirations. The total aspirated volume of one patient exceeded 80 L before pleurodesis. The patients with pleurodesis were well tolerated and had no complications after operation. There was no relapse in follow-up. After pleurodesis,the pleural effusion of all the patients was completely improved. Conclusion The clinical manifestations of refractory pleural effusion are relatively rare in patients with SLE. Drug therapy has poor effect,while traditionally used pleurodesis may be safer and preferred in such cases. It can effectively improve patients' prognosis and quality of life,but due to the small number of reported patients,the best type of intervention waits to be found.
Objective To investigate the effect and feasibility of pleurodesis in the treatment of systemic lupus erythematosus(SLE) complicated with refractory pleural effusion. Methods The clinical data on four patients were diagnosed with SLE complicated with refractory pleural effusion and received pleurodesis was retrospectively analyzed. At the same time,using such terms as " lupus" and " pleural effusion",we searched English literature in Pubmed and in WanFang Database of China. Results A total of 7 cases with relative complete data were found from the literature. Six patients were female,and one was male. Three cases had bilateral pleural effusion,two had left pleural effusion,and two had right pleural effusion. Then,these eleven patients were analyed together. Those patients who suffered significant dyspnea were related to chronic pleural effusion. They were all treated with a large dose of corticosteroid and immunosuppressive agents before pleurodesis,but none of the therapies was valid. They had undergone frequent multiple fluid aspirations. The total aspirated volume of one patient exceeded 80 L before pleurodesis. The patients with pleurodesis were well tolerated and had no complications after operation. There was no relapse in follow-up. After pleurodesis,the pleural effusion of all the patients was completely improved. Conclusion The clinical manifestations of refractory pleural effusion are relatively rare in patients with SLE. Drug therapy has poor effect,while traditionally used pleurodesis may be safer and preferred in such cases. It can effectively improve patients' prognosis and quality of life,but due to the small number of reported patients,the best type of intervention waits to be found.
引文
[1]Sonoda A,Jeudy J,White CS,et al.Pleurodesis:indications and radiologic appearance[J].Jpn J Radiol,2015,33(5):241-245.
[2]Breuer GS,Deeb M,Fisher D,et al.Therapeutic options for refractory massive pleural effusion in systemic lupus erythematosus:a case study and review of the literature[J].Semin Arthritis Rheum,2005,34(5):744-749.
[3]Kaine JL.Refractory massive pleural effusion in systemic lupus erythematosus treated with talc poudrage[J].Ann Rheum Dis,1985,44(1):61-64.
[4]Gilleece MH,Evans CC,Bucknall RC.Steroid resistant pleural effusion in systemic lupus erythematosus treated with tetracycline pleurodesis[J].Ann Rheum Dis,1988,47(12):1031-1032.
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[6]Putterman C,Kramer M,Ben-Chetrit E.Pleurodesis for refractory pleural effusion in systemic lupus erythematosus[J].J Rheumatol,1993,20(11):1990.
[7]Vargas FS,Milanez JR,Filomeno LT,et al.Intrapleural talc for the prevention of recurrence in benign or undiagnosed pleural effusions[J].Chest,1994,106(6):1771-1775.
[8]Hocherg MC.Updating the American College of Rheumatology revised criteria for the c Iassification of systemic iupus erythemalosus[J].Arthritis Rheum,1997,40(9):1725.
[9]王玉华,张国华张令令,等.系统性红斑狼疮合并难治性胸腔积液11例并文献复习[J].中华风湿病学杂志,2016,20(11):755-759.
[10]俞森洋,蔡柏蔷.呼吸内科主治医师660问[M].北京:中国协和医科大学出版社,2009:557.
[11]Schild HH,Strassburg CP,Welz A,et al.Treatment options in patients with chylothorax[J].Dtsch Arztebl Int,2013,110(48):819-826.
[12]Keane MP,Lynch JP III.Pleuropulmonary manifestations of systemic lupus erythematosus[J].Thorax,2000,55(2):159-166.
[13]Haye Salinas MJ,Caeiro F,Saurit V,et al.Pleuropulmonary involvement in patients with systemic lupus erythematosus from a Latin American inception cohort(GLADEL)[J].Lupus,2017,26(13):1368-1377.
[14]Zhao J,Bai W,Zhu P,et al.Chinese SLE Treatment and Research group(CSTAR)registryⅦ:prevalence and clinical significance of serositis in Chinese patients with systemic lupus erythematosus[J].Lupus,2016,25(6):652-657.
[15]Leslie KO,Trahan S,Gruden J.Pulmonary pathology of the rheumatic diseases[J].Semin Respir Crit Care Med,2007,28(4):369-378.
[16]Soysal DE,Hizar Turan S,Ozmen M,et al.A rare case of systemic lupus erythematosus with chylous ascites and chylothorax[J].Case Rep Rheumatol,2013,2013:797696.
[17]Suárez PM,Gilart JL.Pleurodesis in the treatment of pneumothorax and pleural effusion[J].Monaldi Arch Chest Dis,2013,79(2):81-86.
[18]Jung Y.Surgical treatment of hepatic hydrothorax:a"four-step approach"[J].Ann Thorac Surg,2016,101(30):1195-1197.
[2]Breuer GS,Deeb M,Fisher D,et al.Therapeutic options for refractory massive pleural effusion in systemic lupus erythematosus:a case study and review of the literature[J].Semin Arthritis Rheum,2005,34(5):744-749.
[3]Kaine JL.Refractory massive pleural effusion in systemic lupus erythematosus treated with talc poudrage[J].Ann Rheum Dis,1985,44(1):61-64.
[4]Gilleece MH,Evans CC,Bucknall RC.Steroid resistant pleural effusion in systemic lupus erythematosus treated with tetracycline pleurodesis[J].Ann Rheum Dis,1988,47(12):1031-1032.
[5]Mc Knight KM,Adair NE,Agudelo CA.Successful use of tetracycline pleurodesis to treat massive pleural effusion secondary to systemic lupus erythematosus[J].Arthritis Rheum,1991,34(11):1483-1484.
[6]Putterman C,Kramer M,Ben-Chetrit E.Pleurodesis for refractory pleural effusion in systemic lupus erythematosus[J].J Rheumatol,1993,20(11):1990.
[7]Vargas FS,Milanez JR,Filomeno LT,et al.Intrapleural talc for the prevention of recurrence in benign or undiagnosed pleural effusions[J].Chest,1994,106(6):1771-1775.
[8]Hocherg MC.Updating the American College of Rheumatology revised criteria for the c Iassification of systemic iupus erythemalosus[J].Arthritis Rheum,1997,40(9):1725.
[9]王玉华,张国华张令令,等.系统性红斑狼疮合并难治性胸腔积液11例并文献复习[J].中华风湿病学杂志,2016,20(11):755-759.
[10]俞森洋,蔡柏蔷.呼吸内科主治医师660问[M].北京:中国协和医科大学出版社,2009:557.
[11]Schild HH,Strassburg CP,Welz A,et al.Treatment options in patients with chylothorax[J].Dtsch Arztebl Int,2013,110(48):819-826.
[12]Keane MP,Lynch JP III.Pleuropulmonary manifestations of systemic lupus erythematosus[J].Thorax,2000,55(2):159-166.
[13]Haye Salinas MJ,Caeiro F,Saurit V,et al.Pleuropulmonary involvement in patients with systemic lupus erythematosus from a Latin American inception cohort(GLADEL)[J].Lupus,2017,26(13):1368-1377.
[14]Zhao J,Bai W,Zhu P,et al.Chinese SLE Treatment and Research group(CSTAR)registryⅦ:prevalence and clinical significance of serositis in Chinese patients with systemic lupus erythematosus[J].Lupus,2016,25(6):652-657.
[15]Leslie KO,Trahan S,Gruden J.Pulmonary pathology of the rheumatic diseases[J].Semin Respir Crit Care Med,2007,28(4):369-378.
[16]Soysal DE,Hizar Turan S,Ozmen M,et al.A rare case of systemic lupus erythematosus with chylous ascites and chylothorax[J].Case Rep Rheumatol,2013,2013:797696.
[17]Suárez PM,Gilart JL.Pleurodesis in the treatment of pneumothorax and pleural effusion[J].Monaldi Arch Chest Dis,2013,79(2):81-86.
[18]Jung Y.Surgical treatment of hepatic hydrothorax:a"four-step approach"[J].Ann Thorac Surg,2016,101(30):1195-1197.