[1]倪紫微,柴玲姗,周 静,等.蛋白丢失性肠病临床特点分析与预后的关系:系统评价[J].肠外与肠内营养杂志,2020,(04):211-214221.[doi:10.16151/j.1007-810x.2020.04.005]
　NI Zi-wei,CHAI Ling-shan,ZHOU Jing,et al.Analysis of clinicopathological characteristics of protein-losing enteropathy[J].PARENTERAL & ENTERAL NUTRITION,2020,(04):211-214221.[doi:10.16151/j.1007-810x.2020.04.005]
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蛋白丢失性肠病临床特点分析与预后的关系:系统评价
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《肠外与肠内营养》杂志[ISSN:1007-810X/CN:32-1477/R]

卷:
期数:
2020年04期
页码:
211-214221
栏目:
论著
出版日期:
2020-07-10

文章信息/Info

Title:
Analysis of clinicopathological characteristics of protein-losing enteropathy
作者:
倪紫微; 柴玲姗; 周 静; 李 娅; 徐 峰
郑州大学第一附属医院消化内科，河南郑州450052
Author(s):
NI Zi-wei;  CHAI Ling-shan;  ZHOU Jing;  LI Ya;  XU Feng
Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052,Henan,China
关键词:
蛋白丢失性肠病 ; 低白蛋白血症 ; 99mTc标记白蛋白显像
Keywords:
Protein-losing enteropathy;  Hypoalbuminemia;  99mTc-labeled albumin imaging
分类号:
R574
DOI:
10.16151/j.1007-810x.2020.04.005
文献标志码:
A
摘要:
目的：探讨蛋白丢失性肠病（PLE）病人的临床病理特点，为临床诊治提供参考。 方法：回顾性分析2010年10月至2019年10月期间于郑州大学第一附属医院就诊的15例经 99mTc标记白蛋白显像确诊的PLE病人的临床病理资料。 结果：15例PLE病人中，男5例，女10例，年龄5岁~78岁（46.33 ± 21.21）岁。水肿为常见的临床表现。根据影像学检查，合并浆膜腔积液11例。原发病主要为系统性红斑狼疮7例，此外有1例未分化结缔组织病，1例肠结核。严重低蛋白血症、高甘油三酯血症、低钙血症、补体C3降低、CD4+/CD8+T淋巴细胞比例降低对蛋白丢失性肠病的诊断有一定意义。 结论：蛋白丢失性肠病以低蛋白血症、水肿、多浆膜腔积液为主要表现。99mTc标记白蛋白显像是诊断蛋白丢失性肠病的重要方法。治疗以治疗原发病为主，糖皮质激素、免疫抑制剂、肝素、奥曲肽、钙剂等可能对疾病治疗有效。
Abstract:
Objective: To investigate the clinicopathological characteristics of patients with protein-losing enteropathy (PLE) and provide reference for clinical diagnosis and treatment. Methods: The clinical and pathological data of 15 patients with PLE diagnosed by 99mTc-labeled albumin imaging at the First Affiliated Hospital of Zhengzhou University from October 2010 to October 2019 were retrospectively analyzed. Results: Among the 15 patients with PLE, 5 were male and 10 were female, with the ages ranged from 5 to 78 years (46.33 ± 21.21 years). Edema was a common clinical manifestation. According to imaging examination, 11 cases of serous effusion were complicated. The primary disease was mainly systemic lupus erythematosus (n = 7), and other primary diseases included 1 case of undifferentiated connective tissue disease and 1 case of intestinal tuberculosis. Severe hypoproteinemia, hypertriglyceridemia, hypocalcemia, decreased levels of C3, and decreased CD4+/CD8+ T lymphocyte ratio have a certain significance in the diagnosis of PLE. Conclusion: PLE is mainly characterized by hypoproteinemia, edema, and multiple serous effusion. 99mTc-labeled albumin imaging is an important method for its diagnosis. Treatment of primary disease is the mainly approach, and glucocorticoids, immunosuppressive agents, heparin, octreotide, calcium, etc. may be effective for the treatment.

参考文献/References:


[1] Jiri Mestecky, Warren Strober , Michael W.Russell ,et al. Mucosal Immunology (Fourth Edition), 2015.
[2] Levitt DG, Levitt MD. Protein losing enteropathy: comprehensive review of the mechanistic association with clinical and subclinical disease states. Clin Exp Gastroenterol, 2017, 10:147-168.
[3] 甄承恩,胡义亭 . 重视蛋白丢失性肠病 . 临床荟萃,2009,24(12):1090-1093.
[4] Murali A, Narasimhan D, Krishnaveni J, et al. Protein losing enteropathy in systemic lupus erythematosus. J Assoc Physicians India, 2013,61(10):747-749.
[5] Al-Mogairen SM. Lupus protein-losing enteropathy (LUPLE): A systematic review. Rheumatol Int, 2011, 31(8):995-1001.
[6] Kim YG, Lee CK, Byeon JS, et al. Serum cholesterol in idiopathic and lupus-related protein-losing enteropathy. Lupus,2008, 17(6):575-579.
[7] Lan JA, Chervu LR, Marans Z, et al. Protein-losing enteropathy detected by 99mTc-labeled human serum albumin abdominal scintigraphy.J Pediatr Gastroenterol Nutr,1988,7(6):872-876.
[8] Albright F, Bartter FC, Forbes AP. The fate of human serum albumin administered intravenously to a patient with idiopathic hypoalbuminemia and hypoproteinemia. Trans Ass Amer Phycns,1949,204:62.
[9] Khalesi M, Nakhaei AA, Seyed AJ,et al. Diagnostic accuracy of nuclear medicine imaging in protein losing enteropathy :systematic review and meta-analysis of the literature. Acta Gastroenterol Belg, 2013, 76(4):413-422.
[10] Strygler B, Nicar MJ, Santangelo WC, et al. Alpha 1-antitrypsin excretion in stool in normal subjects and in patients with gastrointestinal disorders. Gastroenterology, 1990, 99(5): 1380-1387.
[11] Patil, Navin, Rao, et al. An intriguing cause of chronic diarrhea Protein-losing enteropathy as the presenting manifestation of systemic lupus erythematosus. Asian Journal of Pharmaceutical and Clinical Research, 2017, 10(7), 21-22.
[12] Melenovsky V, Kubanek M, Kacer P. Protein-losing enteropathy in an adult with non-ischaemic cardiomyopathy: complete reversal by heart transplantation. ESC Heart Fail, 2018, 5(5):842-845.
[13] Suehiro K, Morikage N, Murakami M, et al. Late-onset primary intestinal lymphangiectasia successfully managed with octreotide:a case report. Ann Vasc Dis, 2012, 5(1):96-99.
[14] Cappell MS, Edhi A, Amin M. Case report of primary intestinal lymphangiectasia diagnosed in an octogenarian by ileal intubation and by push enteroscopy after missed diagnosis by standard colonoscopy and EGD. Medicine (Baltimore). 2018, 97(3):e9649.
[15] Bhowmick J, Sarkar R, Dhali GK.IDDF2018-ABS-0262 Primary intestinal lymphangiectasia in young adult – a rare cause of protein losing enteropathy. Gut, 2018, 67(Suppl 2):A85-A86.
[16] Thomson M, Frischer-Ravens A, Mylonaki M, et al. Wireless capsule endoscopy in children：a study to assess diagnostic yiald in smaU bowel disease in paediatrlc patients． J Pediatr Gastroenterol Nutr,2007, 44(2):192-197．
[17] Kim SJ, Park IS, Song JY, et a1. Reversal of protein-losing enteropathy with calcium replacement in a patient after Fontan operation．Ann Thorac Surg, 2004, 77(4):1456-1457.

备注/Memo

备注/Memo:
作者简介 ：倪紫微，医学硕士研究生，从事临床消化专业。E-mail：niziwei1996@qq.com 通讯作者 ：徐 峰，E-mail：xufengmd@sina.com
更新日期/Last Update: 1900-01-01