误诊为顽固性低钾血症的干燥综合征一例
A Case of Sjogren’s Syndrome Misdiagnosed as Intractable Hypokalemia
DOI: 10.12677/ACM.2023.133606, PDF,   
作者: 曹靖兰, 陈 婷：济宁医学院临床医学院，山东 济宁；程雪娇, 岳红梅：济宁市第一人民医院神经内科，山东 济宁
关键词: 双下肢疼痛伴无力；干燥综合征；首发症状；Pain and Weakness of Both Lower Limbs； Sjogren’s Syndrome； First Symptom
摘要: 目的：探讨以双下肢疼痛伴无力为首发症状的干燥综合征患者的临床表现，诊疗经过及预后情况。方法：回顾性分析就诊于济宁市人民医院的以双下肢疼痛为首发症状的患者的临床资料。结果：干燥综合征发病机制极为复杂，临床表现多样化，极易漏诊、误诊。以双下肢疼痛为首发症状的干燥综合征合并肾损害极其罕见，临床医师应提高警惕。
Abstract: Objective: To explore the clinical manifestations, diagnosis and treatment and prognosis of Sjogren’s syndrome with pain and weakness of both lower limbs as the first symptom. Methods: The clinical data of patients with pain of both lower limbs as the first symptom in Jining People’s Hospital were retrospectively analyzed. Results: The pathogenesis of Sjogren’s syndrome is ex-tremely complex, and its clinical manifestations are diverse, so it is easy to be missed and misdi-agnosed. Sjogren’s syndrome with renal damage as the first symptom of lower limbs pain is ex-tremely rare, so clinicians should be vigilant.
文章引用：曹靖兰, 陈婷, 程雪娇, 岳红梅. 误诊为顽固性低钾血症的干燥综合征一例[J]. 临床医学进展, 2023, 13(3): 4227-4232. https://doi.org/10.12677/ACM.2023.133606

参考文献

[1] Sanchez-Zuno, G.A., Oregon-Romero, E., Hernandez-Bello, J., et al. (2021) Rheumatic Diseases and Allergies, the Duality of the Immune System. Revista Alergia México, 68, 264-275. [Google Scholar] [CrossRef] [PubMed]
[2] Jonsson, R., Nakken, B., Halse, A.K., et al. (2000) Heredity and Immunology in Sjogren’s Syndrome. Tidsskrift for Den Norske Legeforening, 120, 811-814.
[3] Yoshio, S. (1997) Association of Sjögren’s Syndrome with Hereditary Angioneurotic Edema: Report of a Case. Clinical Immunology and Immunopathology, 84, 95-97. [Google Scholar] [CrossRef] [PubMed]
[4] Maria, M. (2019) The Role of Ep-stein-Barr Virus Infection in Primary Sjögren’s Syndrome. Current Opinion in Rheumatology, 31, 475-483. [Google Scholar] [CrossRef] 
[5] Nakamura, H., Shimizu, T. and Kawakami, A. (2020) Role of Viral Infections in the Pathogenesis of Sjögren’s Syndrome: Different Characteristics of Epstein-Barr Virus and HTLV-1. Journal of Clinical Medicine, 9, 1459. [Google Scholar] [CrossRef] [PubMed]
[6] Huang, Y.F., et al. (2013) The Immune Factors Involved in the Patho-genesis, Diagnosis, and Treatment of Sjogren’s Syndrome. Clinical and Developmental Immunology, 2013, Article ID: 160491. [Google Scholar] [CrossRef] [PubMed]
[7] Roberta, P., Guido, V., et al. (2015) Sex Differences in Sjögren’s Syndrome: A Comprehensive Review of Immune Mechanisms. Biology of Sex Differences, 6, 1-13. [Google Scholar] [CrossRef] [PubMed]
[8] Alani, H., Henty, J.R., Thompson, N.L., et al. (2018) Systematic Review and Meta-Analysis of the Epidemiology of Polyautoimmunity in Sjogren’s Syndrome (Secondary Sjogren’s Syndrome) Focusing on Autoimmune Rheumatic Diseases. Scandinavian Journal of Rheumatology, 47, 141-154. [Google Scholar] [CrossRef] [PubMed]
[9] Xin, L., et al. (2021) Exposure-Lag-Response Associations between Extreme Environmental Conditions and Primary Sjögren’s Syndrome. Clinical Rheumatology, 41, 523-532. [Google Scholar] [CrossRef] [PubMed]
[10] Mavragani, C.P. and Moutsopoulos, H.M. (2009) The Geoepidemiology of Sjögren’s Syndrome. Autoimmunity Reviews, 9, A305-A310. [Google Scholar] [CrossRef] [PubMed]
[11] Trevisani, V., Pinheiro, A.C., de Magalhaes, S.F.S., et al. (2022) Recommendations for Evaluation and Diagnosis of Extra-Glandular Manifestations of Primary Sjogren Syndrome: Results of an Epidemiologic Systematic Review/Meta- Analysis and a Consensus Guideline from the Brazilian Society of Rheumatology (Hepatic, Gastrointestinal and Pancreatic). Advances in Rheumatology, 62, 35. [Google Scholar] [CrossRef] [PubMed]
[12] Vivino, F.B. (2017) Sjogren’s Syndrome: Clinical Aspects. Clinical Immunology, 182, 48-54. [Google Scholar] [CrossRef] [PubMed]
[13] Siso-Almirall, A., Meijer, J.M., Brito-Zeron, P., et al. (2021) Practical Guidelines for the Early Diagnosis of Sjogren’s Syndrome in Primary Healthcare. Clinical and Experimental Rheumatology, 39, 197-205. [Google Scholar] [CrossRef] [PubMed]
[14] Sandrine, J.J. and Guillaume, C. (2020) Current Status of Imaging of Sjogren’s Syndrome. Best Practice & Research Clinical Rheumatology, 34, Article ID: 101592. [Google Scholar] [CrossRef] [PubMed]
[15] Shilpa, S. (2020) Sjogren’s Syndrome. International Journal of Nursing Education and Research, 8, 114-116. [Google Scholar] [CrossRef] 
[16] Sam Shiny, T. and George Rinu, J. (2020) Sjogren’s Syn-drome: An Overview. International Journal of Nursing Education and Research, 8, 539-542. [Google Scholar] [CrossRef] 
[17] Zandonella, C., et al. (2019) Hyperechoic Bands Detected by Salivary Gland Ultrasonography Are Related to Salivary Impairment in Established Sjogren’s Syndrome. Clinical and Experimental Rheumatology, 37, S146-S152.
[18] Rusthen, S., et al. (2019) Dysbiotic Salivary Microbiota in Dry Mouth and Primary Sjögren’s Syndrome Patients. PLOS ONE, 14, e218319. [Google Scholar] [CrossRef] [PubMed]
[19] Rodriguez, M.F., Asnal, C., Gobbi, C.A., et al. (2022) Primary Sjogren Syndrome and Development of Another Autoimmune Rheumatic Disease during the Follow-Up. Advances in Rheumatology, 62, 19. [Google Scholar] [CrossRef] [PubMed]
[20] Berman, N., Vivino, F., Baker, J., et al. (2019) Risk Factors for Caries Development in Primary Sjogren Syndrome. Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, 128, 117-122. [Google Scholar] [CrossRef] [PubMed]
[21] Utomo, S.W. and Putri, J.F. (2020) Infections as Risk Factor of Sjögren’s Syndrome. Open Access Rheumatology: Research and Reviews, 12, 257-266. [Google Scholar] [CrossRef] 
[22] Trevisani, V., Pugliesi, A., Pasoto, S.G., et al. (2022) Recom-mendations for Evaluation and Diagnosis of Extra-Glandular Manifestations of Primary Sjogren Syndrome: Results of an Epidemiologic Systematic Review/Meta- Analysis and a Consensus Guideline from the Brazilian Society of Rheu-matology (Articular, Pulmonary and Renal). Advances in Rheumatology, 62, 18. [Google Scholar] [CrossRef] [PubMed]
[23] Tu, R., et al. (2022) Renal Tubular Acidosis and Nephrogenic Diabetes Insipidus Caused by Sjögren’s Syndrome with Hypokalemic Periodic Paralysis as the First Symptom: A Case Report. Revue Neurologique, 178, 861-864. [Google Scholar] [CrossRef] [PubMed]
[24] Jooha, L.J., Jae, P.Y., Misun, P., et al. (2021) Longitudinal Analysis of Symptom-Based Clustering in Patients with Primary Sjogren’s Syndrome: A Prospective Cohort Study with a 5-Year Follow-Up Period. Journal of Translational Medicine, 19, 394. [Google Scholar] [CrossRef] [PubMed]
[25] Ciro, M., Jordi, S. and Marco, I. (2021) Comment on: Comor-bidities (Excluding Lymphoma) in Sjögren’s Syndrome. Rheumatology (Oxford, England), 60, e453-e454. [Google Scholar] [CrossRef] [PubMed]
[26] Onorina, B., Piero, R., et al. (2021) Association between Minor Salivary Gland Biopsy during Sjӧgren’s Syndrome and Serologic Biomarkers: A Systematic Review and Meta-Analysis. Frontiers in Immunology, 12, Article ID: 686457. [Google Scholar] [CrossRef] [PubMed]
[27] Ainat, K., Jonathan, K., Moran, C., et al. (2022) Acinar Atrophy, Fibrosis and Fatty Changes Are Significantly More Common than Sjogren’s Syndrome in Minor Salivary Gland Biop-sies. Medicina, 58, 175. [Google Scholar] [CrossRef] [PubMed]
[28] Bagga, A. and Sinha, A. (2020) Renal Tubular Acidosis. Indian Journal of Pediatrics, 87, 733-744. [Google Scholar] [CrossRef] [PubMed]
[29] Aiyegbusi, O., Mcgregor, L., Mcgeoch, L., et al. (2021) Renal Disease in Primary Sjögren’s Syndrome. Rheumatology and Therapy, 8, 63-80. [Google Scholar] [CrossRef] [PubMed]
[30] Yayla, M.E., Şahin Eroğlu, D., Uslu, Y.E., et al. (2022) Indica-tions and Risk Factors for Hospitalization in Patients with Primary Sjögren Syndrome: Experience from a Tertiary Center in Turkey. Clinical Rheumatology, 41, 1457-1463. [Google Scholar] [CrossRef] [PubMed]
[31] 刘正钊, 胡伟新, 章海涛, 等. 原发性干燥综合征肾损害的临床病理特征及预后[J]. 肾脏病与透析肾移植杂志, 2010, 19(3): 225-229.
[32] 郑法雷, 赵素梅, 李雪梅, 等. 范可尼综合征的临床特点与生化异常[J]. 中华内科杂志, 2000, 39(11): 14-17.
[33] 周雷, 周玲丽, 徐春兰, 等. 12例肾小管酸中毒患者误诊原因分析与护理[J]. 中国实用护理杂志, 2005, 21(9): 22-23.
[34] 宋捷, 刘正钊, 胡伟新, 等. 75例干燥综合征肾脏损害患者远期预后及影响因素分析[J]. 肾脏病与透析肾移植杂志, 2014, 23(1): 18-22.
[35] 雷鸣, 刘春晓, 曾国华, 等. 含钙性肾结石患者尿液代谢异常、远端肾小管性酸中毒的检测及意义[J]. 山东医药, 2010, 50(10): 74-75.
[36] 穆妮热•阿塔吾拉, 郭艳英. 低钾血症病因与发病机制的研究进展[J]. 中国医药科学, 2022, 12(18): 39-43.
[37] 李东宝, 华琦. 低钾血症的临床处理[J]. 内科急危重症杂志, 2005, 11(2): 87-89.
[38] Phuyal, P. and Nagalli, S. (2022) Hypokalemic Periodic Paralysis.
[39] Louis-Jean, S., Ching, P.R. and Wallingford, A. (2020) Distal Renal Tubular Acidosis in Sjogren’s Syndrome: A Case Report. Cureus, 12, e10962. [Google Scholar] [CrossRef] [PubMed]
[40] George, V., John, W.D., Isaac, P., et al. (2019) Distal Renal Tubular Acidosis and Severe Hypokalemia: A Case Report and Review of the Literature. Journal of Medical Case Reports, 13, 103. [Google Scholar] [CrossRef] [PubMed]
[41] Chalkia, A., Giannou, P., Thomas, K., et al. (2021) Distal Renal Tubular Acidosis and Nephrocalcinosis as Initial Manifestation of Primary Sjogren’s Syndrome. Saudi Journal of Kidney Diseases and Transplantation, 32, 1470-1474.
[42] Tarn, J., Lendrem, D., Mcmeekin, P., et al. (2022) Primary Sjögren’s Syndrome: Longitudinal Real-World, Observational Data on Health-Related Quality of Life. Journal of Internal Medicine, 291, 849-855. [Google Scholar] [CrossRef] [PubMed]
[43] Goules, A.V., Argyropoulou, O.D., Pezoulas, V.C., et al. (2020) Primary Sjgren’s Syndrome of Early and Late Onset: Distinct Clinical Phenotypes and Lymphoma Development. Frontiers in Immunology, 11, Article ID: 594096. [Google Scholar] [CrossRef] [PubMed]
[44] Agata, S., Marta, M., Maciej, S., et al. (2021) Differences in Clinical Phenotypes of Primary Sjögren’s Syndrome Depending on Early or Late Onset. Advances in Clinical and Ex-perimental Medicine: Official Organ Wroclaw Medical University, 30, 1141-1146. [Google Scholar] [CrossRef] [PubMed]
[45] Sebastian, A., Madej, M., Sebastian, M., et al. (2021) Differences in Clinical Phenotypes of Primary Sjogren’s Syndrome Depending on Early or Late Onset. Advances in Clinical and Ex-perimental Medicine, 30, 1141-1146. [Google Scholar] [CrossRef] [PubMed]
[46] Kawada, T. (2022) Smoking, Obesity, and Risk of Primary Sjögren Syndrome. The Journal of Rheumatology, 49, 231-234. [Google Scholar] [CrossRef] [PubMed]
[47] Del Papa, N., Minniti, A., Maglione, W., et al. (2021) Instruments for Outcome Evaluation of Specific Domains in Primary Sjögren’s Syndrome. Biomolecules, 11, 953. [Google Scholar] [CrossRef] [PubMed]
[48] Francois, H. and Mariette, X. (2020) Renal Involvement in Sjogren’s Syndrome. Nephrologie & Therapeutique, 16, 440-452. [Google Scholar] [CrossRef] [PubMed]

为你推荐