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目的 探讨系统性红斑狼疮(systemic lupus erythematosus,SLE)继发气胸的临床特征,增加对其的认识。方法 对1例SLE患者发生急性狼疮性肺炎继发气胸的发病过程、临床表现、胸部影像学特点及诊治经过进行分析。以“systemic lupus erythematosus”和“pneumothorax”为检索词在PubMed数据库进行检索,以“狼疮”和“气胸”为检索词在万方数据库和中国知网数据库中进行检索,检索时间为1971~2016年,复习相关文献。结果 患者,女,26岁,因反复发热3个月,胸闷、气促10 d于2016年12月就诊。诊断为急性狼疮性肺炎。入院后接受糖皮质激素、环磷酰胺及血浆置换等治疗。住院期间患者突发右侧胸痛,胸部CT检查提示右侧气胸,经胸腔闭式引流后好转。检索文献报道14例,其中2例因数据不全被剔除。余下的12例中女9例,男3例。平均年龄(28.0±11.9)岁。其临床表现多为突发胸闷、气促,常伴有胸膜下肺空洞、囊腔状改变。大部分患者经胸腔闭式引流后气胸消失,少数需接受胸腔镜手术。结论 SLE继发气胸罕见,常与SLE继发肺空洞、囊腔破裂有关,大部分患者经胸腔闭式引流术后气胸可治愈。
Objective To investigate the clinical characteristics of systemic lupus erythematosus (SLE) secondary pneumothorax and to increase its understanding. Methods One case of SLE patients with acute lupus pneumonia secondary to pneumothorax incidence, clinical manifestations, chest imaging features and diagnosis and treatment after the analysis. Search with “systemic lupus erythematosus” and “pneumothorax” as search terms in the PubMed database and “wolf” and “pneumothorax” as search terms in the Wanfang database and CNKI database , Retrieved from 1971 to 2016, review the relevant literature. Results The patient, female, aged 26, was admitted to December 2016 due to repeated fever for 3 months, chest tightness and shortness of breath for 10 days. Diagnosis of acute lupus pneumonia. Admitted to receive corticosteroids, cyclophosphamide and plasma exchange therapy. Patients with sudden right chest pain during hospitalization, chest CT examination showed right pneumothorax, after thoracic closed drainage improved. Retrieval literature reported 14 cases, of which 2 cases were excluded due to incomplete data. The remaining 12 cases in 9 women, 3 males. The average age (28.0 ± 11.9) years old. Most of its clinical manifestations of sudden chest tightness, shortness of breath, often accompanied by subpleural lung cavities, cystic changes. Most patients after pneumothorax disappeared after closed thoracic drainage, a small number of patients undergoing thoracoscopic surgery. Conclusions SLE secondary pneumothorax rare, often associated with secondary lung empty SLE, cystic rupture, most patients after thoracic closure drainage pneumothorax can be cured.