以分泌性中耳炎为首诊症状的ANCA相关小血管炎的临床误诊2例  

Clinical misdiagnosis of two cases of ANCA-associated vasculitis with secretory otitis media as the first symptom

作　　者：林丹宇[1] 申宇鹏[1] 李晓明[1] 周永青[1] 程贺娟 魏英粉 LIN Danyu;SHEN Yupeng;LI Xiaoming;ZHOU Yongqing;CHENG Hejuan;WEI Yingfen(Department of Otorhinolaryngology Head and Neck Surgery, Bethune International Peace Hospital, Shijiazhuang 050081, China)

机构地区：[1]白求恩国际和平医院耳鼻咽喉头颈外科,石家庄050081

出　　处：《临床与病理杂志》2018年第12期2738-2742,共5页Journal of Clinical and Pathological Research

基　　金：全军后勤科研计划项目(CBJ12C017)~~

摘　　要：回顾性分析白求恩国际和平医院诊治的2例合并分泌性中耳炎的抗中性粒细胞胞质抗体(antineutrophil cytoplasmic antibody,ANCA)相关小血管炎的临床资料及随访资料。该2例患者早期均出现耳闷、听力下降等分泌性中耳炎症状,完善血清免疫学检查后确诊为ANCA相关小血管炎,积极行激素及免疫治疗,单纯针对中耳炎的治疗效果不良。ANCA相关小血管炎患者临床表现复杂多样,少数病例以分泌性中耳炎或鼻窦炎为首发症状,极易误诊,诊断时不能局限于专科疾病,需结合特异性实验室检查确诊。早期确诊并给予激素及免疫治疗方案,有利于提高疗效和预防疾病进展。The clinical data and follow-up data of two cases of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis accompanied with secretory otitis media in our hospital were retrospectively analyzed. The two cases all presented symptoms of secretory otitis media, such as ear fullness and hearing loss in the early stage. After completing serum immunological examination, they were diagnosed as ANCA-associated vasculitis. Hormone and immunotherapy should be carried out actively, and treatment of otitis media alone is not effective. The clinical manifestations of ANCA-associated vasculitis patients are complex and diverse. In a few cases, secretory otitis media or rhinosinusitis are the first symptom, which is easy to be misdiagnosed. Diagnosis should not be limited to specific diseases, but can be confirmed by specific laboratory examination. Early diagnosis and hormone and immunotherapy regimen are beneficial for improving curative effect and preventing disease progression.

关 键 词：分泌性中耳炎 抗中性粒细胞胞质抗体相关小血管炎 诊断 治疗 

分 类 号：R764.21[医药卫生—耳鼻咽喉科]