临床病例讨论第462例——慢性大量水样泻、急性肾损伤  

The 462nd case： chronic watery diarrhea and acute kidney injury

作　　者：倪岳晖 李骥[2] 周炜洵[3] 罗亚平[4] 蒋青伟[2] 刘洋[1] 乐偲[5] 孙钢[2] 钱家鸣[2] Ni Yuehui, Li Ji, Zhou Weixun, Luo Yaping, Jiang Qingwei, Liu Yang, Yue Cai, Sun Gang, Qian Jiaming(Department of Gastroenterology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, Chin)

机构地区：[1]中国医学科学院北京协和医学院,北京协和医院内科,100730 [2]中国医学科学院北京协和医学院,北京协和医院消化内科,100730 [3]中国医学科学院北京协和医学院,北京协和医院病理科,100730 [4]中国医学科学院北京协和医学院,北京协和医院核医学科,100730 [5]中国医学科学院北京协和医学院,北京协和医院肾内科,100730

出　　处：《中华内科杂志》2018年第4期309-312,共4页Chinese Journal of Internal Medicine

基　　金：北京协和医学院教学质量工程项目（2017zlgc0110）

摘　　要：患者男，60岁。因大量水样泻2个月余就诊，伴体重明显下降，并发急性肾损伤，经多种止泻药物、经验性抗感染及禁食禁水试验、去麦胶饮食等治疗均无明确疗效。在除外肿瘤性疾病、炎症性肠病及感染性腹泻等病因后，结合胃镜病理改变诊断为自身免疫性肠病，予糖皮质激素治疗后病情好转。A 60-year-old man presented with severe watery diarrhea for 2 months complicated with weight loss and acute kidney injury. He did not respond well to antidiarrheal medicines, empirical antibiotics and dietary exclusion of gluten or even complete bowel rest. The final diagnosis of autoimmune enteropathy （AIE） was made based on histopathologic findings of endoscopic biopsy from duodenal mucosa after excluding neoplastic disease, inflammatory bowel disease, and infectious diarrhea, etc. Chronic diarrhea and oliguria alleviated after the administration of corticosteroids.

关 键 词：腹泻 急性肾损伤 自身免疫性肠病 

分 类 号：R574[医药卫生—消化系统] R576[医药卫生—内科学] R692[医药卫生—临床医学]