摘要
目的分析抗中性粒细胞胞浆抗体(antineutrophil cytoplasmic antibody,ANCA)相关性血管炎的临床特点和误诊原因。方法对上海交通大学医学院附属新华医院近2年新确诊且收治入院的16例ANCA相关性血管炎误诊资料进行回顾性分析。结果本组出现咳嗽、咳痰10例,下肢水肿9例,呕吐、腹泻等消化道症状8例,发热6例,咯血、呼吸困难3例,腰痛及关节、肌肉疼痛各2例,眼部炎症1例;其中9例表现为多系统症状体征。病初误诊为肺部感染、肾功能不全6例,肺部感染、肾功能不全、结肠溃疡性疾病2例,肺部感染、肾功能不全、消化道出血各2例,风湿性多肌痛1例,肺部感染、肾功能不全、消化道出血、眼部感染1例。误诊时间最短10 d,最长3年余。根据临床症状和自身免疫抗体及病理检查结果,明确ANCA相关性血管炎诊断,确诊后予糖皮质激素、环磷酰胺、血浆置换等治疗,随访至今1例需永久血液透析治疗,4例死亡。结论 ANCA相关性血管炎初期临床表现多样,容易误漏诊;对于出现多器官受累且病情迁延不愈者需考虑本症,常规筛查自身免疫抗体有助于本病诊断,必要时可行活检明确诊断。
Objective To summarize the clinical features and causes of misdiagnosis of antineutrophil cytoplasmic antibody(ANCA)associated vasculitis.Methods The clinical data of 16 adults with newly diagnosed ANCA who were admitted to Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine in the past two years were analyzed retrospectively.Results Of all patients,there were 10 cases of cough and expectoration,9 cases of lower limb edema,8 cases of digestive tract symptoms such as vomiting and diarrhea,6 cases of fever,3 cases of hemoptysis and dyspnea,2 cases of low back pain,2 cases of joint and muscle pain,and 1 case of ocular inflammation.Of them,9 patients showed multi-systemic signs and symptoms.Six cases were initially misdiagnosed as pulmonary infection and renal dysfunction,2 cases as pulmonary infection,renal dysfunction,and colonic ulcer disease,2 cases as pulmonary infection,2 cases as renal dysfunction,2 cases as haemorrhage of digestive tract,1 case as rheumatic polymyalgia,and 1 case as pulmonary infection,renal dysfunction,haemorrhage of digestive tract and ophthalmic infection.The duration of misdiagnosis ranged from 10 days to more than 3 years.According to the clinical symptoms,autoimmune antibody detection,and results of pathological examination,ANCA associated vasculitis was confirmed.Therefore,the patients were treated with glucocorticoid,cyclophosphamide and plasmapheresis.At the latest follow-up,1 patient required permanent hemodialysis and 4 died.Conclusion Diversity of clinical manifestations in early stages typically leads to missed diagnosisi or misdiagnosis of ANCA.For patients with multiple organ involvement and prolonged disease,the disease should be suspected.Regular screening of autoimmune antibodies may contribute to the diagnosis of this disease,which may also be confirmed by biopsy when necessary.
作者
王翠翠
费爱华
WANG Cui-cui;FEI Ai-hua(Emergency Department, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200091, China)
出处
《临床误诊误治》
2019年第1期1-6,共6页
Clinical Misdiagnosis & Mistherapy
基金
上海市科学技术委员会基金项目(17d22307600)
上海交通大学医学院附属新华医院院基金(XHECC-2015-047-2)
关键词
抗中性粒细胞胞浆抗体相关性血管炎
误诊
肾功能不全
Antineutrophil cytoplasmic antibody associated vasculitis
Misdiagnosis
Renal dysfunction
作者简介
通讯作者:费爱华,E-mail:feiaihua@xinhuamed.com.cn
