抗中性粒细胞胞质抗体相关血管炎性中耳炎  

Otitis media with antineutrophil cytoplasmic antibody-associated vasculitis

作　　者：张玉忠[1] 赵欢娣 陈耔辰 任鹏宇[1] 侯薇 张勤[3] 吴琼[3] 金玉莲 杨军[3] 张青[1] ZHANG Yuzhong;ZHAO Huandi;CHEN Zichen;REN Pengyu;HOU Wei;ZHANG Qin;WU Qiong;JIN Yulian;YANG Jun;ZHANG Qing(Department of Otorhinolaryngology Head and Neck Surgery,the Second Affiliated Hospital of Xi'an Jiaotong University,Xi'an,710004,China;Department of Otorhinolaryngology Head and Neck Surgery,the Affiliated Hospital of Shaanxi University Chinese Medicine;Department of Otorhinolaryngology-Head and Neck Surgery,Xinhua Hospital,Shanghai Jiaotong University School of Medicine,Shanghai Jiaotong University School of Medicine Ear Institute,Shanghai Key Laboratory of Translational Medicine on Ear and Nose diseases)

机构地区：[1]西安交通大学第二附属医院耳鼻咽喉头颈外科,西安710004 [2]陕西中医药大学附属医院耳鼻咽喉头颈外科 [3]上海交通大学医学院附属新华医院耳鼻咽喉-头颈外科,上海交通大学医学院耳科学研究所,上海耳鼻疾病转化医学重点实验室

出　　处：《临床耳鼻咽喉头颈外科杂志》2022年第8期630-635,共6页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

基　　金：国家自然科学基金资助项目(No:81970891,82171137);陕西省国际合作重点研发计划项目(No:2020KWZ-019)。

摘　　要：目的:探讨抗中性粒细胞胞质抗体(ANCA)相关血管炎性中耳炎(OMAAV)的临床特征、诊断和治疗。方法:报告3例OMAAV患者的诊治过程,结合文献探讨该疾病的临床特点和诊疗方案。结果:本组3例患者发病年龄56~72岁,男性2例,女性1例。3例患者与普通中耳炎的不同之处在于:①2例鼓膜表面出现肉芽样外观和血性分泌物;②骨导听力进行性下降;③2例出现周围面神经麻痹;④实验室检查ANCA阳性;⑤对普通中耳炎的常规治疗无效,使用糖皮质激素联合免疫抑制剂治疗效果良好。结论:OMAAV临床较为少见,在临床诊治中容易发生误诊和漏诊;早期明确诊断并使用糖皮质激素联合免疫抑制剂是治疗的关键。有创检查和手术治疗可能会加重症状,不宜实施。Objective: To analyze clinical features,diagnosis and treatment of otitis media with antineutrophil cytoplasmic antibody(ANCA)-associated vasculitis(OMAAV).Methods: This study reported three OMAAV patients and discussed the diagnosis and treatment of OMAAV combined with the recent literature.Results: Two males and one female were included.The age of these three patients ranged from 56 to 72 years.Their characteristics were as follows:①tympanic membrane with granulation and bloody secretions in two patients;②progressive bone-conducted hearing loss within a short period of time;③facial palsy in two patients;④the laboratory test of ANCA is positive;⑤conventional treatment of otitis media is ineffective,while glucocorticoid combined with immunosuppressive therapy is effective.Conclusion: OMAAV is a rare disease and prone to misdiagnosis.Early diagnosis and treatment with corticosteroids and immunosuppressants are critical.Invasive tests and surgery during the active phase of OMAAV may aggravate symptoms and should be avoided.

关 键 词：中耳炎 抗中性粒细胞胞质抗体 原发性血管炎 

分 类 号：R764.21[医药卫生—耳鼻咽喉科]