显微镜下型多血管炎一例误诊分析  

Misdiagnosis Analysis of a Patient with Microscopic Polyangiitis(MPA)

作　　者：常娟[1] 茅宇烽[1] 张翀[1,2] 罗勇[3,4] 

机构地区：[1]上海交通大学医学院附属新华医院崇明分院肾内科,上海202150 [2]上海交通大学医学院附属新华医院肾内科,上海200092 [3]上海交通大学医学院附属新华医院崇明分院呼吸科,上海202150 [4]上海交通大学医学院附属新华医院呼吸科,上海200092

出　　处：《临床误诊误治》2012年第8期19-21,共3页Clinical Misdiagnosis & Mistherapy

摘　　要：目的探讨显微镜下型多血管炎(MPA)的临床和病理表现,以减少误诊。方法回顾分析1例MPA误诊病例的临床资料,并复习相关文献。结果患者因肾功能不全1.5年,咳嗽、痰中带血1周并无尿1 d入院。1.5年前因下肢水肿、少尿在外院经相关检查诊断为肾功能不全、干燥综合征。入我院后完善实验室检查,查核周型抗中性粒细胞胞浆抗体(P-ANCA)和对应靶抗原-髓过氧化物酶(MPO-ANCA)均(+),确诊为MPA。经糖皮质激素、环磷酰胺治疗,病情缓解出院。结论 MPA临床表现多种多样,轻重不一,临床上遇及不明原因肾功能不全伴肺部病变者应考虑MPA,需行抗中性粒细胞胞浆抗体检测和肾病理检查助诊。Objective To analyzed the c finical and pathological manifestations of microscopic polyangiitis （MPA） in order to reduce misdiagnosis rate. Methods A retrospective analysis was performed on misdiagnosed clinical data of a patient with MPA and pertinent literature was reviewed. Results This patient was admitted for renal insufficieney for one and a half years, cough and hemoptysis tor one week and anuria for one day. The patient had suffered from lower extrelnity edema anti oliguria and had been diagnosed as having kidney insufficieney and sjogren syndrome in other hospitals 1. 5 years before be admitted in our hospital. Our laboratury exanfinatiun showed perinuclear antineutrophil cytoplasmic antibodies pusilive （P-ANCA） and target antigen, myeloperoxidase （MPO-ANCA）. The final diagnosis was MPA. The pathogenetic condition was relieved after glucocorticoid and cyclophosphamide treatment. Conclusion Cfinic.al manilestations of MPA have an extremely wide spectrum. For patients with renal failure of unknown reason combined with pulmonary morbid change should take ANCA test and renal biopsy in order to exclude MPA.

关 键 词：血管炎 抗体 抗中性白细胞胞质 误诊 肾功能衰竭 干燥综合征 

分 类 号：R593.2[医药卫生—内科学]