目的 探讨老年系统性红斑狼疮(systemic lupus erythematosus,SLE)的临床特征及误诊原因,提出防范措施.方法 对我院收治的以多浆膜腔积液和IgE显著升高为特点的老年SLE 1例的临床资料进行回顾性分析.结果 本例因咳嗽、气促先后3次在我院就诊,表现为胸腔积液、心包积液、IgE升高及多发淋巴结增大,误诊为肺炎,经抗感染、平喘等处理,症状未见明显好转,且伴有浆膜腔积液增多、IgE显著升高,血红蛋白、血小板、补体C3、C4下降,球蛋白升高等多系统损害,请风湿科会诊确诊为SLE,予抗炎、免疫抑制等治疗后病情好转出院.随访3个月,患者一般情况良好.结论 接诊难以解释的多浆膜腔积液、IgE升高者要考虑到SLE的可能,尽早行相关检查,避免或减少误诊误治.%Objective To analyze clinical features and the causes of misdiagnosis and preventive measures of systemic lupus erythematosus ( SLE) in the elderly. Methods The clinical data of an elderly SLE patient with polyserous effusions and significantly elevated immunoglobulin E ( IgE) in our hospital was retrospectively analyzed. Results This patient was admitted to our hospital for three times with cough and shortness of breath. The main man-ifestations included pleural effusion, pericardial effusion, elevated IgE and multiple enlarged lymph nodes, which were misdiagnosed as pneumonia. Anti-infection and antiasthetic treatment were not effective. Whatˊs worse, multi-systematic damage occurred subsequently, such as pleural and pericardial effusion, significantly increased IgE level, declined hemoglobin, platelet and complement C3, C4, as well as increased globulin. After consultation of rheuma-tologist, she was diagnosed as SLE and given anti-inflammatory and immunosuppressive treatment, and subsequently, the condition was improved. After three months of follow-up, the patient was in good condition. Conclusion In the elderly patients with unexplained polyserous effusions and elevated IgE, SLE should be considered. Relevant tests should be performed as early as possible in order to avoid or reduce misdiagnosis and mistreatment.
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