崔艳杰?宋广梅?周毅?朱丽花

【摘要】SLE是一种典型的自身免疫性结缔组织疾病，可累及全身多个器官和组织。该文报告一例SLE合并缺铁性贫血患者，对其诊断、治疗和发生缺铁性贫血的机制进行分析。该例为28岁女性患者，入院诊断为SLE，经治疗病情稳定并纠正贫血后，再次出现中度贫血，给予口服和静脉铁剂治疗后患者贫血可短暂改善，考虑与其长期服用质子泵抑制剂有关，经停用质子泵抑制剂并继续予铁剂治疗，贫血缓解。该例诊治提示，SLE患者长期服用质子泵抑制剂可增加缺铁性贫血的发生风险，其机制可能是通过影响铁的吸收而发挥作用。

【关键词】系统性红斑狼疮;缺铁性贫血;质子泵抑制剂

Systemic lupus erythematosus complicated with iron deficiency anemia： a case report Cui Yanjie， Song Guangmei， Zhou Yi， Zhu Lihua. Department of Rheumatology and Immunology， the First Affiliated Hospital of Jinan University， Guangzhou 510630， China Corresponding author， Zhu Lihua， E-mail： 125741799@qq.com

【Abstract】Systemic lupus erythematosus （SLE） is a typical autoimmune connective tissue disorder that can affect multiple organs and tissues throughout the body. In this article， one case of SLE complicated with iron deficiency anemia was reported， and the diagnosis， treatment and pathogenesis of SLE complicated with iron deficiency anemia were analyzed. The 28-year-old female patient was diagnosed with SLE upon admission. After corresponding treatment， the disease condition was stabilized and the symptom of anemia was mitigated. Subsequently， she developed moderate anemia again， which was temporarily alleviated after oral and intravenous iron therapy. It was considered to be associated with long-term use of proton pump inhibitors. The symptom of anemia was relieved by discontinuation of proton pump inhibitors and persistent iron therapy. The diagnosis and treatment of this case prompt that long-term use of proton pump inhibitors might increase the risk of iron deficiency anemia possibly by affecting the iron absorption in SLE patients.

【Key words】Systemic lupus erythematosus; Iron deficiency anemia; Proton pump inhibitor

SLE是一種典型的自身免疫性结缔组织疾病，可累及全身多个器官和组织，好发于育龄期女性。疾病急性期的快速诊断、诱导缓解并制定个体化的治疗方案是控制SLE的关键。对急性期的重症SLE患者，常以大剂量糖皮质激素（激素）冲击及细胞毒性药物迅速控制病情，后以小剂量激素和免疫抑制剂防止疾病的复发。若SLE患者没有得到及时规范治疗，可能会出现肺、肾等重要脏器的损伤，严重者甚至危及生命。临床医师使用激素治疗时，常规辅以PPI预防胃黏膜损伤，PPI所引起的缺铁性贫血往往被忽视。为使临床医师提高警惕，现报告1例SLE合并缺铁性贫血患者的诊治过程。

病例资料

一、病史及体格检查

患者女，28岁。因反复多关节肿痛1年余于2010年8月12日入院。1年前患者无明显诱因出现双手近端指间关节肿痛，病情逐渐加重，累及双手近十个近端指间关节，伴晨僵，持续时间超过半个小时。……