变应性肉芽肿性血管炎并发神经系统受累五例临床分析  

Clinical features of allergic granulomatosis polyangiitis with neurologic involvement:an analysis of 5 cases

作　　者：卢正娟[1] 罗云[1] 刘卓[1] Lu Zhengjuan;Luo Yun;Liu Zhuo(Department of Neurology,Nanjing Drum Tower Hospital,Nanjing University,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属南京鼓楼医院神经内科,210008

出　　处：《中华全科医师杂志》2020年第3期246-249,共4页Chinese Journal of General Practitioners

摘　　要：回顾性分析南京鼓楼医院2013年1月至2019年8月确诊、住院治疗的10例变应性肉芽肿性血管炎(AGPA)患者的临床资料。10例中5例出现神经系统受累,其中3例以周围神经病为首发表现,1例周围神经和中枢神经系统同时受累。5例周围神经受累患者中,2例表现为多发性单神经病,3例为多发性神经病。所有患者急性或亚急性起病,肢体麻木疼痛症状为突出表现。电生理检查发现感觉和运动传导波幅显著降低或消失。10例中8例应用激素联合免疫抑制剂治疗,2例单用激素治疗。8例预后良好,2例患者死亡。提示,AGPA患者常见周围神经受累;当患者出现急性或亚急性起病的轴索性周围神经病合并血嗜酸性粒细胞数明显升高时,需考虑AGPA的可能。Ten patients with allergic granulomatosis with polyangiitis(AGPA)were admitted in Nanjing Drum Tower Hospital during January 2013 to August 2019,among whom 5 cases with neurologic involvement.The clinical features,laboratory findings and clinical outcome of the 5 patients were analyzed and literature review was performed.Among 5 cases of AGPA with neurologic involvement,3 presented with peripheral neuropathy as the initial symptom,2 had multiple mononeuropathy,3 had distal asymmetric or symmetric polyneuropathy.All five patients had acute or subacute onset,and the symptoms of limb numbness or pain were prominent.Electrophysiological examination showed that sensory and motor conduction amplitude significantly decreased or disappeared.Eight of the 10 AGPA patients were treated with corticosteroid combined with immunosuppressants,2 were treated with corticosteroid alone.Eight patients had good prognosis and 2 patients died.The results suggest that peripheral neuropathy is common in AGPA.When the patients present with acute or subacute onset of axonal impairment of peripheral neuropathy and elevated eosinophils,AGPA should be considered.

关 键 词：血管炎 变应性肉芽肿性 周围神经系统 病理状态 体征和症状 

分 类 号：R593[医药卫生—内科学] R74[医药卫生—临床医学]