胆固醇结晶栓塞误诊原因分析及诊疗建议  

Analysis of Misdiagnosed Causes and Diagnosis and Treatment Suggestions of Cholesterol Crystal Embolization

作　　者：鞠上[1] 刘宇静 张晓福 王刚[1] 高瑜[3] 曹欣[3] 闫程程 王宁[3] 

机构地区：[1]北京中医药大学东直门医院血管外科,北京100700 [2]陆军总医院医学工程科,北京100700 [3]北京中医药大学,北京100029

出　　处：《临床误诊误治》2017年第7期21-24,共4页Clinical Misdiagnosis & Mistherapy

摘　　要：目的探讨胆固醇结晶栓塞(cholesterol crystal embolism,CCE)的临床特点、误诊原因及诊疗策略。方法对近年我院收治的3例CCE误诊病例资料进行回顾性分析。结果 3例因下肢动脉硬化闭塞症行下肢动脉腔内成形术治疗,术后均出现足趾端皮肤蓝紫色病变,误诊为蓝趾综合征,后出现肾功能指标异常升高,C-反应蛋白升高,红细胞沉降率增快,嗜酸粒细胞增多,其中2例及时明确CCE诊断,并停用抗凝溶栓治疗,预后良好;1例未停用抗凝溶栓治疗,最终因多脏器功能衰竭死亡。结论动脉粥样硬化患者若行血管介入操作后,嗜酸粒细胞及炎性指标升高,出现皮肤病变、难以解释的肾损伤和消化道或神经系统表现时,应考虑CCE,多次组织病理学检查可明确诊断。Objective To investigate clinical features, misdiagnosed causes and diagnosis and treatment strategy of cholesterol crystal embolization （CCE）. Methods Clinical data of 3 misdiagnosed patients with CCE admitted in recent years was retrospectively analyzed. Results The 3 patients with lower limb arteriosclerosis occlusion underwent lower limb intracavity angioplasty treatment, all patients had postoperative lyons blue lesions in toe extremitates skin, and then all patients were misdiagnosed as having blue toe syndrome. Abnormally increased values of renal function level, c-reaction protein （CRP） , erythrocyte sedimentation rate and eosinophils were found in 3patients, of whom 2 patients were timely confirmed the diagnosis of CCE, and were forbidden with anticoagulation and thrombolytic therapy, and the prognoses were good by follow-up; 1 patient was continuously treated with anticoagulation and thrombolysis, and finally died of multiple organ failure. Conclusion If patients with atherosclerosis have increased eosinophils and inflammatory index levels, skin lesions, unexplained renal injury, gastrointestinal or neurological manifestations after vascular intervention, and CCE should be considered, and therefore histopathologic examination for many times can confirm the diagnosis.

关 键 词：栓塞 胆固醇 动脉粥样硬化 误诊 蓝趾综合征 

分 类 号：R543[医药卫生—心血管疾病]