ANCA相关性血管炎并肠道损害长时间误诊分析  

Analysis of Long-term Misdiagnosis of ANCA-associated Vasculitis with Intestinal Damage

作　　者：张安兴 罗娟[1] 牛俊坤[1] 缪应雷[1] ZHANG An-xing;LUO Juan;NIU Jun-kun;MIAO Ying-lei(Department of Gastroenterology,the First Affiliated Hospital of Kunming Medical University,Kunming 650032,China)

机构地区：[1]昆明医科大学第一附属医院消化内科,昆明650032

出　　处：《临床误诊误治》2018年第9期10-13,共4页Clinical Misdiagnosis & Mistherapy

基　　金：国家自然科学基金(81670501)

摘　　要：目的探讨抗中性粒细胞胞浆抗体(antineutrophil cytoplasmic antibodies,ANCA)相关性血管炎(ANCA-associated vasculitis,AAV)并肠道损害的临床特征,分析误诊原因。方法对误诊为溃疡性结肠炎的AAV并肠道损害1例的临床资料进行回顾性分析。结果本例因反复排黏液血便5年余,出现皮肤结节2年入院。曾误诊为溃疡性结肠炎,予相关治疗后病情仍反复发作。入我院后完善相关检查并请多学科会诊,确诊为AAV并肠道损害,予甲泼尼龙琥珀酸钠、沙利度胺治疗后病情好转出院。随访10个月,大便正常,皮损多数愈合,病情未复发。结论临床遇及多系统受累且久治不愈的疾病时,应拓展诊断思维,考虑到AAV可能,提高确诊率。Objective To investigate the clinical features of antineutrophil cytoplasmic antibodies（ANCA）-associated vasculitis（AAV） with intestinal damage and to analyze the causes of misdiagnosis. Methods Clinical data of a case of AAV with intestinal damage misdiagnosed as ulcerative colitis were retrospectively analyzed. Results The patient was admitted to our hospital because of repeated mucus stool for more than 5 years and skin nodules for two years. He was misdiagnosed as having ulcerative colitis,which was recurrent after treatment. After admission to our hospital,based on relevant examinations and multidisciplinary consultation,the patient was diagnosed with AAV and intestinal damage. He was discharged from hospital after treatment with methylprednisolone sodium succinate and thalidomide. At 10-month follow-up,he had normal bowel movement,and nodules on the skin were basically healed without recurrence. Conclusion In terms of refractory diseases with multi-system involvement,AAV should be suspected in clinical settings,thus improving the rate of diagnosis.

关 键 词：抗中性粒细胞胞浆抗体相关性血管炎 误诊 溃疡性结肠炎 

分 类 号：R543.63[医药卫生—心血管疾病]