中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2013年
11期
837-840
,共4页
肥厚性硬脑膜炎%抗中性粒细胞胞质抗体%血管炎
肥厚性硬腦膜炎%抗中性粒細胞胞質抗體%血管炎
비후성경뇌막염%항중성립세포포질항체%혈관염
Hypertrophic pachymeningitis%Antineutrophil cytoplasmic antibody%Vasculitis
目的 探讨核周型-抗中性粒细胞胞质抗体(p-ANCA)相关性肥厚性硬脑膜炎的临床特点、诊治方法及预后.方法 回顾性分析2005至2012年天津医科大学总医院收治的6例p-ANCA相关性肥厚性硬脑膜炎患者的临床资料.结果 6例患者中男、女各3例,发病年龄52～ 68岁.临床主要表现为头痛及多组颅神经损伤.病情活动期所有患者红细胞沉降率、C反应蛋白、髓过氧化物酶(MPO)-ANCA浓度及脑脊液蛋白含量均升高,p-ANCA阳性而胞质型(c)-ANCA均为阴性.诊断此病头MRI增强扫描敏感性较高,6例均可见不同部位的硬脑膜增厚并明显强化.所有患者糖皮质激素治疗有效,2例随访期间病情复发,需加用免疫抑制剂治疗.结论 对头痛、颅神经损伤并伴有p-ANCA阳性的中老年患者应考虑患有本病可能,头MRI增强扫描有助于诊断.
目的 探討覈週型-抗中性粒細胞胞質抗體(p-ANCA)相關性肥厚性硬腦膜炎的臨床特點、診治方法及預後.方法 迴顧性分析2005至2012年天津醫科大學總醫院收治的6例p-ANCA相關性肥厚性硬腦膜炎患者的臨床資料.結果 6例患者中男、女各3例,髮病年齡52～ 68歲.臨床主要錶現為頭痛及多組顱神經損傷.病情活動期所有患者紅細胞沉降率、C反應蛋白、髓過氧化物酶(MPO)-ANCA濃度及腦脊液蛋白含量均升高,p-ANCA暘性而胞質型(c)-ANCA均為陰性.診斷此病頭MRI增彊掃描敏感性較高,6例均可見不同部位的硬腦膜增厚併明顯彊化.所有患者糖皮質激素治療有效,2例隨訪期間病情複髮,需加用免疫抑製劑治療.結論 對頭痛、顱神經損傷併伴有p-ANCA暘性的中老年患者應攷慮患有本病可能,頭MRI增彊掃描有助于診斷.
목적 탐토핵주형-항중성립세포포질항체(p-ANCA)상관성비후성경뇌막염적림상특점、진치방법급예후.방법 회고성분석2005지2012년천진의과대학총의원수치적6례p-ANCA상관성비후성경뇌막염환자적림상자료.결과 6례환자중남、녀각3례,발병년령52～ 68세.림상주요표현위두통급다조로신경손상.병정활동기소유환자홍세포침강솔、C반응단백、수과양화물매(MPO)-ANCA농도급뇌척액단백함량균승고,p-ANCA양성이포질형(c)-ANCA균위음성.진단차병두MRI증강소묘민감성교고,6례균가견불동부위적경뇌막증후병명현강화.소유환자당피질격소치료유효,2례수방기간병정복발,수가용면역억제제치료.결론 대두통、로신경손상병반유p-ANCA양성적중노년환자응고필환유본병가능,두MRI증강소묘유조우진단.
Objective To explore the clinical characteristics,diagnosis,treatment and prognosis of perinuclear antineutrophil cytoplasmic antibody (p-ANCA) associated hypertrophic pachymeningitis.Methods A retrospective study was performed for 6 inpatients with p-ANCA associated hypertrophic pachymeningitis at our hospital from 2005 to 2012.Results There were 3 males and 3 females with an age range of 52-68 years.The main clinical manifestations included headache and multiple cranial neuropathies.Erythrocyte sedimentation rate,C-reactive protein,titer of myeloperoxidase (MPO)-ANCA and protein in cerebrospinal fluid were uniformly elevated in all 6 patients during active phase while cytoplasmic (c)-ANCA was all negative.Head magnetic resonance imaging (MRI) enhancement scan had a high diagnostic sensitivity.Different parts of dura were all thickened and obviously enhanced.Glucocorticoid was uniformly effective.During the follow-up period,2 cases relapsed and received immunosuppressive agents.Conclusion The disease should be considered in elderly patients with headache,cranial nerve injury and positive p-ANCA.And head MRI enhancement scan is helpful for diagnosis.
