以双侧胸腔积液为首发表现的原发性干燥综合征一例报道并文献复习

doi:10.12114/j.issn.1007-9572.2018.00.211

摘要/Abstract

摘要： 目的　探讨以双侧胸腔积液为首发表现的原发性干燥综合征的临床特点和治疗措施。方法　回顾性分析杭州市红十字会医院呼吸科2016-05-09收治的1例以双侧胸腔积液为首发表现的原发性干燥综合征患者的临床资料并进行相关文献复习。以“干燥综合征”“胸腔积液”为检索词检索万方数据知识服务平台和中国知网（CNKI），以“Sjogren's syndrome”“pleural effusion”为检索词检索PubMed、EMBase数据库，检索时间为1975—2015年。结果　本例患者女，73岁，因“咳嗽及活动后胸闷2年，加重1个月”入院。临床表现为咳嗽，活动后胸闷，胸部B超提示双侧胸腔积液。血常规示白细胞计数降低，抗核抗体阳性，抗SSA、SSB抗体阳性；胸腔积液抗核抗体阳性，抗SSA、SSB抗体阳性。给予免疫调节及激素治疗后胸腔积液吸收好转。文献检索后经过筛选剔除，共检索出文献12篇，加上本例患者共13例，其中男5例，女8例；年龄40~73岁；主要症状为发热、咳嗽、胸痛、呼吸困难；大部分血清及胸腔积液抗核抗体、抗SSA、SSB抗体阳性；细胞分类以淋巴细胞为主。结论　原发性干燥综合征合并胸腔积液少见，临床表现无特异性，诊断明确后治疗以免疫调节及激素为主。原发性干燥综合征致胸腔积液机制并不清楚，仍然需要进一步探究。

关键词: 干燥综合征；胸腔积液；抗体, 抗核；抗SSA抗体；抗SSB抗体；病例报告

Abstract: Objective　To study the clinical characteristics and treatment of primary Sjogren's syndrome （PSS） with bilateral pleural effusion （BPE） as the initial manifestation.Methods　 We retrospectively analyzed the clinical data of a case of PSS with BPE as the initial manifestation who received inpatient treatment from Respiratory Department，Hangzhou Red Cross Hospital on May 9，2016.Moreover，we reviewed the studies about the treatment for PSS with BPE as the initial manifestation published from 1975 to 2015 collected from the electronic databases of Wanfang Data Knowledge Service Platform，CNKI，PubMed and EMBase by searching with terms “Sjogren's syndrome” and “pleural effusion”.Results　 Our case was a 73-year-old woman，who was admitted to hospital due to suffering from cough and chest tightness after exercise for 2 years，and the symptoms aggravated for 1 month.Clinical manifestations were cough and chest tightness after exercise.B-mode ultrasound assessment of the chest identified BPE.Routine blood test found decreased white blood cell count，antinuclear antibodies，anti-SSA and anti-SSB antibodies.BPE analysis detected antinuclear antibodies anti-SSA and anti-SSB antibodies.After receiving treatment for regulating immune responses and hormone therapy，the BPE was absorbed，and the conditions were improved.12 studies were included after screening based on the inclusion and exclusion criteria.The totaled 13 cases （our case and 12 cases reported by the included studies） include 5 males and 8 females aged 40-73，with fever，cough，chest pain and breathing difficulty as the main manifestations，and lymphocytes accounting for most of the white blood cells.Moreover，most of these cases were found with antinuclear antibodies，anti-SSA and anti-SSB antibodies in serum and pleural effusion.Conclusion　PSS with pleural effusion is rare without specific clinical features，which is mainly treated by immunoregulation and hormone therapies after a definite diagnosis is made.The mechanism of pleural effusion associated with PSS is not clear and requires further exploration.

Key words: Sjogren's syndrome；Pleural effusion；Antibodies, antinuclear；Anti-SSA；Anti-SSB；Case reports

陈爱凤,沈晓强,谢文君,等. 以双侧胸腔积液为首发表现的原发性干燥综合征一例报道并文献复习[J]. 中国全科医学, 2019, 22(17): 2136-2140. DOI: 10.12114/j.issn.1007-9572.2018.00.211.
CHEN Aifeng,SHEN Xiaoqiang,XIE Wenjun, et al. Primary Sjogren's Syndrome with Bilateral Pleural Effusion as the Initial Manifestation：a Case Report and Literature Review　[J]. Chinese General Practice, 2019, 22(17): 2136-2140. DOI: 10.12114/j.issn.1007-9572.2018.00.211.

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