狼疮性肠炎还是炎症性肠病：1例合并胃肠道症状的系统性红斑狼疮诊治报告

doi:10.12372/jcp.2026.24e0351

摘要/Abstract

摘要：

系统性红斑狼疮（SLE）和炎症性肠病（IBD）是两种以异常免疫应答为特征的系统性疾病，发病原因主要由易感基因和环境因素之间的相互作用，在临床中，这两种疾病同时发生比较少见。本例报告中，患儿，女，以腹痛起病入院，经检查诊断为系统性红斑狼疮、溃疡性结肠炎。经英夫利昔单抗（IFX）联合免疫抑制剂治疗，患儿自身免疫症状得到缓解。因此，对患有SLE的患者出现胃肠道症状如腹痛或腹泻时，特别是如果与SLE发作无关，应谨慎排除IBD。

关键词: 系统性红斑狼疮, 溃疡性结肠炎, 英夫利昔单抗, 儿童

Abstract:

Systemic lupus erythematosus (SLE) and inflammatory bowel disease (IBD) are chronic systemic autoimmune conditions marked by aberrant immune activation. The pathogenesis of both diseases is multifactorial, involving a complex interplay between genetic susceptibility and environmental influences. Although the simultaneous presence of SLE and IBD is uncommon in clinical practice, this report describes a pediatric female patient who presented with abdominal pain as the primary manifestation and was ultimately diagnosed with both SLE and ulcerative colitis. Treatment with infliximab (IFX), a tumor necrosis factor-α inhibitor, in combination with immunosuppressive therapy led to significant alleviation of her autoimmune and gastrointestinal symptoms. This case highlights the importance of maintaining a high index of suspicion for underlying IBD when evaluating SLE patients with unexplained gastrointestinal complaints—particularly abdominal pain or diarrhea—that do not correlate with typical disease flares.

Key words: systemic lupus erythematosus, ulcerative colitis, infliximab, child

中图分类号:

梁志如, 郭林梅, 王霏, 赵晓云. 狼疮性肠炎还是炎症性肠病：1例合并胃肠道症状的系统性红斑狼疮诊治报告[J]. 临床儿科杂志, 2026, 44(1): 56-63.

LIANG Zhiru, GUO Linmei, WANG Fei, ZHAO Xiaoyun. Lupus enteritis or inflammatory bowel disease: a report of the diagnosis and treatment of systemic lupus erythematosus complicated with gastrointestinal symptoms[J]. Journal of Clinical Pediatrics, 2026, 44(1): 56-63.

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患儿主要诊疗方案及病程时间轴"

时间	临床表现、检查及治疗方案
2018年2月	间断腹痛伴双下肢疼痛10天，发热1天。血常规示WBC 2.44×10⁹·L^-1、NEU 1.19×10⁹·L^-1、RBC 2.19×10¹²·L^-1、 Hb 63g·L^-1、PLT 195×10⁹·L^-1；粪常规示隐血试验弱阳性；ESR 77 mm·h^-1；ANA阳性（1∶320）、抗dsDNA抗体弱阳性、抗Sm抗体阳性、抗rRNP抗体阳性、抗U1-snRNP抗体阳性。诊断为SLE、心包积液、重度缺铁性贫血，给予泼尼松（10 mg，tid）治疗。
2018年3月	发热伴间断腹痛7天，体温39 ℃，入院后诊断为SLE活动期。给予泼尼松（25 mg，bid）联合环磷酰胺冲击治疗。
2020年2月	于第11次环磷酰胺冲击前3天出现频繁呕吐伴剑突下疼痛，头颅核磁及腰椎穿刺未见异常，诊断为活动性SLE、LE。院内甲泼尼龙冲击（600 mg，qd）联合静注免疫球蛋白（10 g，qd）治疗3天。出院后给予泼尼松（15 mg，qd）联合羟氯喹（0.08 g，bid）治疗。
2022年8月	发热伴腹痛、稀便2天，腹部核磁示腹腔内部分肠管扩张并积液、积气；肝左内叶囊肿；腹膜后、双侧髂血管旁及腹股沟区多发增大淋巴结；盆腔少量积液。胃镜下见贲门炎症。诊断为LE、肝囊肿。给予泼尼松（30 mg，qd）联合羟氯喹（0.075 g，bid）、吗替麦考酚酯（0.75 g，bid）。
2023年9月	腹痛4天，考虑低活动性SLE，给予抗感染、调理肠道菌群、保护胃肠黏膜治疗。继续给予泼尼松联合羟氯喹、吗替麦考酚酯治疗。
2024年1月	右上腹持续钝痛6天，无发热。血常规示WBC 10.51×10⁹·L^-1、NEU 9.63×10⁹·L^-1、LYM 0.27×10⁹·L^-1、PLT 239×10⁹·L^-1；CRP 74.8 mg·L^-1；ANA（1∶320）、抗rRNP抗体阳性、抗U1-snRNP抗体阳性；ESR 47 mm·h^-1。肠镜检查示升结肠肝曲侧-横结肠中段见多发半环周不规则溃疡形成，覆白苔，周围黏膜充血。病理结果示黏膜组织，灶性上皮脱落，肉芽组织增生，间质炎细胞浸润，符合溃疡征象，伴急性活动期炎症改变。诊断为SLE、UC。给予泼尼松（40 mg·d^-1）、羟氯喹（0.075 g，bid）、吗替麦考酚酯（0.75 g，bid）联合英夫利昔单抗治疗。
2024年3月	入院复查，给予英夫利西单抗序贯治疗。ANA阳性（1∶100）、抗rRNP抗体阳性、抗U1-snRNP抗体阳性； ESR 8 mm·h^-1，肠镜显示横结肠中段见半环周浅溃疡形成。覆薄白苔，周围黏膜充血，呈挛缩、缩窄状。其对侧见白色瘢痕形成。较未治疗前溃疡数量明显减少、面积缩小，呈愈合趋势。
2025年4月	入院复查，ANA阳性（1∶100）、抗rRNP抗体阳性、抗U1-snRNP抗体阳性；便常规示正常。肠镜显示降结肠、直肠黏膜略肿胀，血管网清晰，肠管舒缩好，未见异常病变。

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