第486例--慢性腹泻,直立性低血压  

The 486th case:chronic diarrhea and orthostatic hypotension

作　　者：王强[1] 龙章彪 钱敏[3] 冯俊[4] 郭潇潇[5] 杨爱明[1] 游燕[6] 费贵军[1] Wang Qiang;Long Zhangbiao;Qian Min;Feng Jun;Guo Xiaoxiao;Yang Aiming;You Yan;Fei Guijun(Department of Gastroenterology,Peking Union Medical College Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Hematology,the First Affiliated Hospital of Anhui Medical University,Hefei 230022,China;Department of Neurology,Peking Union Medical College Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Hematology,Peking Union Medical College Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Cardiology,Peking Union Medical College Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Pathology,Peking Union Medical College Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]中国医学科学院,北京协和医学院,北京协和医院消化内科,100730 [2]安徽医科大学第一附属医院血液内科,合肥230022 [3]中国医学科学院,北京协和医学院,北京协和医院神经内科,100730 [4]中国医学科学院,北京协和医学院,北京协和医院血液内科,100730 [5]中国医学科学院,北京协和医学院,北京协和医院心内科,100730 [6]中国医学科学院,北京协和医学院,北京协和医院病理科,100730

出　　处：《中华内科杂志》2021年第3期284-288,共5页Chinese Journal of Internal Medicine

摘　　要：患者男,57岁,因腹泻10个月,头晕4个月入院。患者每天1~2 L水样便,不含脓血,禁食试验阳性,胃肠镜检查无异常发现,血红蛋白及白蛋白大致正常;同时伴有双下肢感觉异常以及显著的直立性低血压症状。既往有多年的血糖异常及长期大量饮酒史。入院后经多科讨论,通过腓肠神经活检找到了淀粉样变的证据,并结合尿免疫固定电泳、血清游离轻链及心肌核磁检查,确诊为轻链型淀粉样变。予马法兰联合地塞米松化疗后病情缓解。A 57-year-old man was admitted to hospital with diarrhea for 10 months and dizziness for 4 months.The patient had 1-2 liters watery stool per day,without pyogenic blood or abnormality in gastroenteroscopy examination.The level of hemoglobin and albumin was generally normal,and fasting test was positive.At the same time,he was accompanied with hyperalgesia of lower limbs and orthostatic hypotension.After the discussion of multiple disciplinary teams,the patient was diagnosed with amyloidosis by sural nerve biopsy,myocardial MRI,and the assays of urine immunoelectrophoresis and serum free light chain.Light chain amyloidosis was confirmed after excluded the diagnosis of familial amyloidosis.The patient was improved after courses of chemotherapy with melphalan and dexamethasone.

关 键 词：腹泻 低血压 直立性 腓肠神经 淀粉样变性 

分 类 号：R587.2[医药卫生—内分泌] R544.2[医药卫生—内科学]