系统性红斑狼疮患者的肝脏受累研究进展

Research Progress of Liver Involvement in Patients with Systemic Lupus Erythematosus

摘要: 系统性红斑狼疮(systemic lupus erythematosus, SLE)患者在病程中常伴有肝功能异常，由狼疮本病导致的肝损伤称为狼疮性肝炎(lupus hepatitis, LH)。系统性红斑狼疮患者肝脏受累的临床症状通常是轻微和非特异性的，例如：恶心、乏力、腹胀、腹痛等，肝衰竭、非肝硬化门静脉高压、肝性脑病等情况罕见。目前狼疮性肝炎的发病机制尚不明确，有文献推测补体沉积和血管炎是两种可能的机制。狼疮性肝炎尚无统一的诊断标准，需除外其他病因，必要时需通过肝穿刺活检来明确病因诊断。狼疮性肝炎被认为是SLE疾病活动的结果，且与疾病活动度相关的指标密切相关，予以激素及免疫抑制剂治疗后，肝酶水平随着疾病的控制而显著下降。本文对PubMed数据库进行全面的文献检索，对LH的发病机制、临床特点、诊断和治疗等研究进展进行讨论并作一综述。

Abstract: Patients with systemic lupus erythematosus (systemic lupus erythematosus, SLE) are often accom-panied with abnormal liver function during the course of the disease. The liver injury caused by SLE is called lupus hepatitis (lupus hepatitis, LH). The clinical symptoms of liver involvement in patients with systemic lupus erythematosus are usually mild and non-specific, such as nausea, fatigue, ab-dominal distension, abdominal pain and so on. Liver failure, non-cirrhotic portal hypertension and hepatic encephalopathy are rare. At present, the pathogenesis of lupus hepatitis is not clear, and some literatures speculate that complement deposition and vasculitis are two possible mecha-nisms. There is no unified diagnostic standard for lupus hepatitis, and other causes should be ex-cluded. If necessary, liver biopsy should be used to confirm the etiological diagnosis. Lupus hepatitis is considered to be the result of SLE disease activity, and is closely related to disease activity. After treatment with hormones and immunosuppressants, liver enzyme levels decreased significantly with the control of the disease. This paper makes a comprehensive literature search of PubMed da-tabase, and discusses and reviews the research progress on the pathogenesis, clinical features, di-agnosis and treatment of LH.