摘要
临床部分SLE患者可继发抗磷脂抗体综合征(APS),但同时合并非细菌性心内膜炎的患者则较为罕见。该文报道1例SLE继发APS合并Libman-Sacks心内膜炎患者的诊治过程。该患者入院前有发热、关节痛、咽痛和皮疹,入院后UCG示二尖瓣前叶赘生物形成,查狼疮抗体、抗磷脂抗体、狼疮样抗凝物试验阳性,经抗感染治疗后病情未缓解,后患者突发头晕、口周麻木、构音不清、吞咽困难,查头颅MRI见一新发的延髓梗死灶。结合患者临床表现、体征及辅助检查,诊断为APS,Libman-Sacks心内膜炎,延髓梗死,SLE。予免疫抑制、免疫调节、低分子肝素抗凝等治疗后患者病情好转出院。该例的诊治提示,在UCG发现赘生物时,不仅要考虑感染性心内膜炎,同时需要考虑SLE继发APS可能,尤其是对于既往无明确心瓣膜病病史的年轻女性,早期诊断APS合并Libman-Sacks心内膜炎,并给予个体化抗凝治疗,可取得良好疗效。
In clinical practice,partial patients with systemic lupus erythematosu(SLE)can develop secondary antiphospholipid antibody syndrome(APS),whereas simultaneous complication with non-bacterial endocarditis is rarely encountered.In this article,the diagnosis and treatment of one case of APS secondary to SLE complicated with Libman-Sacks endocarditis were reported.Prior to admission,the patient presented with fever,joint pain,sore throat and rash.UCG upon admission revealed the mass in the anterior leaflet of mitral valve.The patient was tested positive for lupus antibody,antiphospholipid antibody and lupus-like anticoagulant test.The symptoms were not alleviated after anti-infection therapy.Subsequently,the patient suffered from dizziness,numbness around the mouth,unclear articulation and dysphagia.Cranial MRI revealed a new medullary infarction lesion.Combined with clinical manifestations,physical signs and auxiliary examinations,the patient was diagnosed with APS,Libman-Sacks endocarditis,medullary infarction and SLE.After immunosuppression,immunomodulation and low-molecule heparin anticoagulation interventions,the patient was improved and discharged from hospital.The diagnosis and treatment of this case prompted that besides IE,the possibility of APS secondary to SLE should also be considered when UCG revealed a neoplasm,especially for young women who had no clear history of valvular heart diseases.Early diagnosis of APS complicated with Libman-Sacks endocarditis and individualized anticoagulation therapy can yield favorable clinical efficacy.
作者
卢丽娟
黄勤
Lu Lijuan;Huang Qin(Internal Medicine Training Base,Shenzhen People’s Hospital,Shenzhen 518000,China)
出处
《新医学》
2021年第1期70-73,共4页
Journal of New Medicine
