摘要
目的研究复发性多软骨炎（RP）的临床特点，以期达到对该病早期诊治的目的。方法回顾性分析郑州大学第一附属医院呼吸科、风湿科和耳鼻喉科1996年4月—2011年10月诊治的23例RP患者临床资料和预后。结果23例患者中；耳廓软骨受累19例，关节软骨17例，鼻软骨14例，呼吸道软骨10例，眼部6例，内耳4例，肋软骨3例，肾脏1例；红细胞沉降率增快者18例，c反应蛋白增高者16例，类风湿因子阳性者2例。呼吸道受累者纤维喉镜检查示喉黏膜水肿，声带麻痹；纤维支气管镜检查示气管黏膜高度水肿，管腔狭窄；颈部CT示喉黏膜肿胀，声门裂变小，喉软骨吸收变形；胸部CT示气管黏膜增厚，管腔狭窄，气管软骨变形、钙化；气管软骨病理检查示：软骨组织退行性变，纤维化，软骨周围肉芽组织增生，炎细胞浸润。23例患者分别应用抗生素、激素、免疫抑制剂及气管切开、气管内支架置入等不同方法治疗，2例窒息死亡，1例心肌梗死死亡，其余20例症状不同程度缓解。结论复发性多软骨炎临床表现多样，呼吸道受累者预后差，早期诊断，正确治疗，可控制症状，改善预后。
Objective To explore the clinical characteristics of relapsing polychondritis （RP） for its early diagnosis and treatment. Methods A retrospective analysis was performed for the clinical data and prognoses for 23 RP patients from April 1996 to October 2011 at Departments of Respiratory Medicine, Rheumatism and Otorhinolaryngology, First Affiliated Hospital, Zhengzhou University. Results Lesion locations included auricle （n = 19）, joints （ n = 17 ）, nose （ n = 14）, respiratory tract （ n = 10 ）, eyes （ n = 6）, inner ear （ n = 4）, costal cartilage （ n = 3 ） and kidney （ n = 1 ）. Laboratory examinations revealed elevated erythrocyte sedimentation rate （ESR） （n = 18）, elevated C-reactive protein （CRP） （ n = 16） and positive rheumatoid factor （n = 2）. Laryngeal mucosa was edematous and the vocal cords were paralyzed in the cases with airway involvement under laryngofiberscopy. Tracheal mucosa was highly edematous and tracheal lumen narrowed in the cases examined under bronchofibroscope. Laryngeal mucosa was swollen, glottic chink narrowed, laryngeal cartilage partially absorbed and deformed in the cases examined with neck computed tomography （CT）. Tracheal mucosa was thickened, tracheal lumen narrowed and tracheal cartilage was deformed and calcified in the cases on chest CT. Pathological examination on tracheal cartilage showed that cartilage tissue was degenerative and fibrotic. And the proliferation of granulation tissue and the infiltration of inflammatory ceils were present around cartilage tissue. Twenty-three RP patients received the therapies of antibiotics, glucocorticosteroid, immunosuppressive agent, tracheotomy or tracheal stent implantation. Two cases died of asphyxia. One case died of myocardial infarct. The symptoms of other 20 cases improved in different degrees. Conclusion The clinical manifestations are diverse in RP patients. The prognoses of patients with airway involvement are worse and may be improved by an early diagnosis and correct treatment.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2012年第16期1126-1128,共3页
National Medical Journal of China
关键词
多软骨炎
复发性
治疗
预后
Polychondritis, relapsing
Treatment
Prognosis
