摘要
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.
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.
出处
《中国医师进修杂志》
2014年第7期20-22,共3页
Chinese Journal of Postgraduates of Medicine
关键词
抗体
抗中性白细胞胞质
误诊
肉芽肿性多血管炎
Antibodies, antineutrophil cytoplasmic
Diagnostic errors
Granulomatosis with polyangitis
