中国医师进修杂志
中國醫師進脩雜誌
중국의사진수잡지
CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
2014年
7期
20-22
,共3页
刘璠%谭伟%封辰叶%康健
劉璠%譚偉%封辰葉%康健
류번%담위%봉신협%강건
抗体,抗中性白细胞胞质%误诊%肉芽肿性多血管炎
抗體,抗中性白細胞胞質%誤診%肉芽腫性多血管炎
항체,항중성백세포포질%오진%육아종성다혈관염
Antibodies,antineutrophil cytoplasmic%Diagnostic errors%Granulomatosis with polyangitis
目的 总结和分析肺脏肉芽肿性多血管炎的临床特点和误诊现状,提高该病的诊疗水平.方法 回顾性收集47例肺脏肉芽肿性多血管炎病例,总结其临床资料和误诊情况,分析误诊原因.结果 患者最常见被误诊为肺部感染性疾病(61.8％,34/55),其次为肺部恶性肿瘤(27.3％,15/55).6.4％(3/47)患者同时有下呼吸道受累.70.2％(33/47)患者有鼻和鼻窦受累,40.4％(19/47)患者有肾脏受累,25.5％(12/47)患者有皮疹,19.1％(9/47)患者有眼部受累,6.4％(3/47)患者有周围性神经炎,6.4％(3/47)患者有消化道出血,4.3％(2/47)患者有心包积液.87.2％(41/47)患者胞质型抗中性粒细胞胞质抗体阳性,76.6％(36/47)患者蛋白酶3阳性.结论 肺脏肉芽肿性多血管炎患者几乎都有肺外的多系统受累,常被误诊为肺部感染性疾病和恶性肿瘤.不断提高临床医生对该病的认识,并在可疑患者中进行胞质型抗中性粒细胞胞质抗体筛查可能减少对该病的误诊.
目的 總結和分析肺髒肉芽腫性多血管炎的臨床特點和誤診現狀,提高該病的診療水平.方法 迴顧性收集47例肺髒肉芽腫性多血管炎病例,總結其臨床資料和誤診情況,分析誤診原因.結果 患者最常見被誤診為肺部感染性疾病(61.8％,34/55),其次為肺部噁性腫瘤(27.3％,15/55).6.4％(3/47)患者同時有下呼吸道受纍.70.2％(33/47)患者有鼻和鼻竇受纍,40.4％(19/47)患者有腎髒受纍,25.5％(12/47)患者有皮疹,19.1％(9/47)患者有眼部受纍,6.4％(3/47)患者有週圍性神經炎,6.4％(3/47)患者有消化道齣血,4.3％(2/47)患者有心包積液.87.2％(41/47)患者胞質型抗中性粒細胞胞質抗體暘性,76.6％(36/47)患者蛋白酶3暘性.結論 肺髒肉芽腫性多血管炎患者幾乎都有肺外的多繫統受纍,常被誤診為肺部感染性疾病和噁性腫瘤.不斷提高臨床醫生對該病的認識,併在可疑患者中進行胞質型抗中性粒細胞胞質抗體篩查可能減少對該病的誤診.
목적 총결화분석폐장육아종성다혈관염적림상특점화오진현상,제고해병적진료수평.방법 회고성수집47례폐장육아종성다혈관염병례,총결기림상자료화오진정황,분석오진원인.결과 환자최상견피오진위폐부감염성질병(61.8％,34/55),기차위폐부악성종류(27.3％,15/55).6.4％(3/47)환자동시유하호흡도수루.70.2％(33/47)환자유비화비두수루,40.4％(19/47)환자유신장수루,25.5％(12/47)환자유피진,19.1％(9/47)환자유안부수루,6.4％(3/47)환자유주위성신경염,6.4％(3/47)환자유소화도출혈,4.3％(2/47)환자유심포적액.87.2％(41/47)환자포질형항중성립세포포질항체양성,76.6％(36/47)환자단백매3양성.결론 폐장육아종성다혈관염환자궤호도유폐외적다계통수루,상피오진위폐부감염성질병화악성종류.불단제고림상의생대해병적인식,병재가의환자중진행포질형항중성립세포포질항체사사가능감소대해병적오진.
Objective To summarize and evaluate the clinical feature and misdiagnosis of pulmonary granulomatosis with polyangitis (GPA).Methods The clinical data of 47 patients of pulmonary GPA were analyzed retrospectively.The clinical feature and misdiagnosis were summarized.Results These patients were most commonly misdiagnosed as pulmonary infectious disease (61.8％,34/55) and pulmonary malignancy (27.3％,15/55) was the next in line.70.2％(33/47) patients had nose and sinus involvement,40.4％(19/47) patients had kidney involvement,25.5％ (12/47) patients had rash,19.1％(9/47) patients had eyes involvement,6.4％ (3/47) patients had peripheral neuritis,6.4％ (3/47) patients had gastrointestinal bleeding,4.3％(2/47) patients had pericardial effusion,87.2％(41/47) patients had positive for antineutrophil cytoplasmic(cANCA),76.6％(36/47) patients had positive for proteinase-3.Conclusions Almost all pulmonary GPA patients have extra-pulmonary multi-systemic involvement.They are often misdiagnosed as pulmonary infectious diseases and malignancy.Educating doctors on GPA constantly and screening possible patients with cANCA testing may help reduce the misdiagnosis.
