目的 提高对显微镜下多血管炎(MPA)的影像学和临床表现的认识。
方法 对确诊的一例以多叶段肺实变为特征的MPA患者进行回顾性分析。
结果 患者以咳嗽、咳痰、咯血伴发热1周, 心悸、气短2 d入院。临床出现镜下血尿, 蛋白尿, 心律失常, 巩膜炎, 耳廓皮肤红肿, 贫血, 体重下降等多系统损害。血沉明显增快(150 mm/1 h), 经多种抗菌素、抗病毒药物等治疗无效。在CT定位下经皮肺穿刺活检提示韦格纳肉芽肿, 核周型抗中性粒细胞胞质抗体阳性, 诊断为MPA。给予强的松联合环磷酰胺治疗, 临床症状明显缓解, 实验室指标好转。
结论 临床中对双肺多叶段实变, 伴无法解释的临床多系统损害, 经抗炎、抗病毒等治疗无效时, 要考虑到MPA, 应及时行经肺活检及抗中性粒细胞胞质抗体检查以早期诊断, 给予糖皮质激素联合环磷酰胺治疗, 疗效佳。
Citation:
刘兵厚, 陶丙岭, 周霞, 刘荣梅, 叶寰. 显微镜下多血管炎并双肺多叶段实变一例报告和分析. Chinese Journal of Respiratory and Critical Care Medicine, 2015, 14(5): 493-495. doi: 10.7507/1671-6205.2015120
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- 1. Savage CO, Harper L, Adu D. Primary systemic vasculitis. Lancet, 1997, 349:553-558.
- 2. Guillevin L, Durand-Gasselin B, Cevallos R, et al. Microscopic polyangiitis:clinical and laboratory findings in eighty-five patients. Arthritis Rheum, 1999, 42:421-430.
- 3. 吴东海等主编.临床风湿病学2008版.北京:人民卫生出版社, 2008.
- 4. Hagen EC. Daha MR, Hermans J, et al. Diagnostic value of seandardized assays for anti-neutrophil cytoplasmic antibodies in idiopthicsystemic-vasulieis. EC/BCR project for ANCA Assay standardization. Kidney Int, 1998, 53:743-753.
- 5. Bosch X, Guilabert A, Espinosa G, et al. Treatment of antineutrophil cytoplasmic antibody associated vasculitis:a systematic review. JAMA, 2000, 298:655-669.