Clinical Characteristics And Risk Factors Of Lupus Mesenteric Vasculitis

Background and purposeLupus mesenteric vasculitis(LMV)is a rare complication of systemic lupus erythematosus(SLE)involving gastrointestinal tractis.It is mainly characterized by non-specific symptoms such as abdominal pain,diarrhea,nausea and vomiting.The more serious cases are rapidly progressive and life-threatening.Studies have shown that LMV has a good response to high-dose hormones.If it can be diagnosed as soon as possible,it is of great significance to improve the prognosis of patients.At present,the diagnosis of LMV is very challenging for the following reasons:1.The gastrointestinal manifestations of LMV patients are not specific.8%to 40%of systemic lupus erythematosus patients have gastrointestinal symptoms,resulting in a variety of causes of gastrointestinal symptoms in lupus patients,when patients with abdominal pain,diarrhea and other symptoms,the diagnosis has a wide range of differences.2.Up to now,the classification standard of SLE does not cover gastrointestinal manifestations.When some patients visit the department of gastroenterology,emergency department or gastrointestinal surgery with acute abdominal pain,diarrhea and other abdominal symptoms as the first symptoms,they are often unable to make a definite diagnosis,resulting in misdiagnosis,mistreatment,and even death due to delay in the best time for diagnosis and treatment.3.So far,there is no clear diagnostic criteria for LMV,and the diagnosis of LMV mainly depends on abdominal CT scan.However,these CT signs mimic mesenteric ischemia and lack specificity,which can also be seen in patients with pancreatitis,mechanical intestinal obstruction,peritonitis or inflammatory bowel disease.There are no exclusion criteria to exclude possible complications such as pseudo-intestinal obstruction,pancreatitis,peritonitis,inflammatory bowel disease and splenic infarction,so the specificity of diagnosis is limited.This paper summarizes and expounds the clinical features,laboratory examination and CT signs of lupus mesenteric vasculitis,in order to better provide clinicians with ideas for diagnosis and treatment,promote cross-disciplinary cooperation,make a clear diagnosis in time,give the best treatment,and improve the survival rate of patients.Methods57 SLE patients with LMV and 114 SLE patients without LMV in the first affiliated Hospital of Zhengzhou University from 2013 to 2020 were analyzed retrospectively.The clinical manifestations,laboratory examination,imaging features,treatment methods and prognosis were summarized,and analyzing the risk factors of LMV.Results1)The main clinical features of LMV were abdominal pain,nausea and vomiting,diarrhea and abdominal distension,and often complicated with polyserous effusion,respiratory or renal system involvement.2)Compared with the group without LMV,the level of lymphocyte count decreased,the titer of complement C3 decreased,the titer of complement C4 decreased,D-II polymer level increased,serum albumin level decreased,inflammatory index increased,urinary protein positive rate increased,The quantity of urinary protein is increased,fecal occult blood positive rate increased,ascites positive rate increased,SLEDAI score increased.3)The imaging features of LMV:increased density of mesenteric fat,thickening of intestinal wall,dilatation of intestinal segment,"target sign",ascites and CT findings associated with urinary tract damage.4)All patients were treated with glucocorticoid,56 cases were effective and 1 case died of pulmonary infection.5)After treatment,the level of D-Ⅱ polymer,C-reactive protein and ESR decreased.6)Logistic regression model showed that D-Ⅱ aggregate level(OR=2.570,95%CI:1.114～5.926,P=0.027),ascites(OR=115.153,95%CI:11.5131～1151.737,P<0.001)were significantly correlated with LMV.ConclusionLMV is rare and often complicated with multiple serous effusion,respiratory or renal system involvement;increased level of D-Ⅱ polymer and ascites are risk factors of LMV;LMV respond well to high-dose glucocorticoid treatment.