以反复心力衰竭及肾周感染为特征的免疫球蛋白G4相关疾病1例  

Immunoglobulin G4⁃related disease characterized by recurrent heart failure and perirenal infection:A report of one case

作　　者：蔡凤丹 杨海峰 林文秋 梁嘉华 陈雪吟 包崑 CAI Fengdan;YANG Haifeng;LIN Wenqiu;LIANG Jiahua;CHEN Xueyin;BAO Kun(The Second Clinical Medical College of Guangzhou University of Chinese Medicine,Guangzhou,Guangdong 510403,China;Department of Pathology,The Second Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou,Guangdong 510120,China;Department of Nephrology,The Second Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou,Guangdong 510120,China)

机构地区：[1]广州中医药大学第二临床医学院,广东广州510403 [2]广州中医药大学第二附属医院病理科,广东广州510120 [3]广州中医药大学第二附属医院肾内科,广东广州510120

出　　处：《安徽医药》2021年第12期2466-2470,共5页Anhui Medical and Pharmaceutical Journal

摘　　要：目的探讨免疫球蛋白G4(IgG4)相关疾病(IgG4-related disease,IgG4-RD)的临床表现、诊断和治疗。方法回顾分析2020年1月广州中医药大学第二附属医院收治的1例IgG4-RD病人的临床资料,并结合文献进行探讨总结。结果该51岁男性病人主要以反复心力衰竭及肾周感染为起病表现,经颌下肿物、肾活检穿刺确诊为IgG4-RD,通过激素治疗后症状改善出院,经随访复查病人血肌酐水平由725μmol/L降至107μmol/L,心脏射血分数由68%上升至75%,提示病人心、肾功能均有所恢复未再复发。结论IgG4-RD可累及多个器官损害,临床表现多样,容易混淆,诊断难度大,而反复心力衰竭发作亦可能作为IgG4-RD的早期起病表现,因此,在临床诊疗中应注意鉴别,减少误诊。Objective To explore the clinical manifestation,diagnosis and treatment of immunoglobulin G4(IgG4)related disease(IgG4-RD).Methods A retrospective analysis was made of a case on IgG4-RD treated in The Second Affiliated Hospital of Guangzhou University of Chinese Medicine in January 2020,and a summary and discussion was also carried out based on literature review.Re⁃sults The main manifestations of this 51-year-old male patient were recurrent heart failure and perirenal infection.The patient was confirmed to develop IgG4-RD by transmandibular mass and renal tissue biopsy.The symptoms were gradually improved after treat-ment with prednisone.Follow-up reexamination showed that the patient's blood creatinine level decreased from 725μmol/L to 107μmol/L,and the cardiac ejection fraction rose from 68%to 75%,suggesting that the patient's heart and kidney function had recovered and no recurrence occurred.Conclusions This case suggests that IgG4-RD can involve multiple organ damages.The symptoms are so diverse that it is easy to get confused and difficult to make confirmed diagnosis.Recurrent heart failure may be an early manifestation of IgG4-RD,thus importance needs to be attached to differential diagnosis in clinical practice to reduce misdiagnosis.

关 键 词：自身免疫疾病 心力衰竭 肾周炎 肾功能不全 免疫球蛋白G4相关疾病 感染 心血管 

分 类 号：R593.2[医药卫生—内科学]