抗中性粒细胞胞浆抗体(ANCA)相关血管炎性中耳炎的诊治分析  

Otitis Media with Antineutrophil Cytoplasmic Antibody(ANCA)-associated Vasculitis(OMAAV):Definition and Early Diagnosis

作　　者：张志坚[1] 任杰[1] 曹永茂[1] 廖华[1] 杨希林[1] 徐勇[1] 汪雷[1] 王文静[1] 华清泉[1] Zhang Zhijian;Ren Jie;Cao Yongmao;Liao Hua;Yang Xilin;Xu Yong;Wang Lei;Wang Wenjing;Hua Qingquan(Department of Otolaryngology&Head and Neck Surgery,Renmin Hospital of Wuhan University,Wuhan,430060,China)

机构地区：[1]武汉大学人民医院耳鼻咽喉头颈外科中心,武汉430060

出　　处：《听力学及言语疾病杂志》2022年第6期617-622,共6页Journal of Audiology and Speech Pathology

基　　金：国家自然科学基金面上项目(81271073);教育部留学回国基金(302-153775)。

摘　　要：目的探讨抗中性粒细胞胞浆抗体(ANCA)相关血管炎性中耳炎(otitis media with antineutrophil cytoplasmic antibody-associated vasculitis,OMAAV)的临床特点及诊治方法。方法在中国知网、维普、万方等中文数据库中,检索以分泌性中耳炎为首发症状的ANCA相关血管炎临床病例,结合1例经治的OMAAV病例,总结其临床特点、诊治及预后。结果检索到以分泌性中耳炎为首发症状的ANCA相关血管炎相关文献5篇病例7例,加上本研究的1例(简称“本例”)共8例患者,均以分泌性中耳炎为首发症状,其中3例继发耳痛,3例继发鼓膜紧张部穿孔,1例出现面瘫。除本例患者外,其余7例均在出现发热、肺部结节等耳部以外表现后方得以确诊,确诊时间1月~3年,平均10.3月,其中5例确诊依据是耳部以外组织活检加ANCA血清学检查,2例是临床表现加ANCA血清学检查;2例死于ANCA相关血管炎,其余5例经治疗后病情缓解。本例患者根据日本耳科学会最近提出的OMAAV诊断标准确诊并及时给予激素和硫唑嘌呤治疗,预后良好。结论以分泌性中耳炎、周围性面瘫及耳痛等耳部症状为首发症状的ANCA相关血管炎早期临床症状不典型,极易误诊。建议根据OMAAV相关诊断标准早期进行规范诊治,减少误诊漏诊,改善预后。Objective To investigate the clinical characteristics,diagnosis and treatment of otitis media with antineutrophil cytoplasmic antibody(ANCA)-associated vasculitis(OMAAV).Methods A case of ANCA-associated vasculitis with secretory otitis media as the first symptom treated in our department and 7 similar cases from literatures were retrospectively analyzed.The clinical manifestation,the process of diagnosisand the prognosis of these cases were summarized and compared.Results Secretory otitis media was the first symptom in all the 8 patients.Among them,3 cases had secondary earache,3 cases had secondary perforation of tympanic membrane,and 1 case had facial paralysis.Except for this case,the other 7 cases were diagnosed after the development of symptoms other than the ear such as fever and pulmonary nodules.The time of diagnosis ranged from 1 month to 3 years,with an average of 10.3 months.Among the 7 cases,5 cases were diagnosed by biopsy of tissues other than the ear and ANCA serology,while 2 cases were diagnosed by clinical manifestations and ANCA serology.Among the 7 patients,2 died of ANCA related vasculitis,and the remaining 5 patients were relieved after treatment.Our patient was promptly diagnosed according to the diagnostic criteria of OMAAV recently proposed by the Japanese Academy of Otology and was given steroid and azathioprine treatment in time,symptoms were relieved after timely treatment.Conclusion Ear symptoms such as refractory otitis media,peripheral facial paralysis and otalgia can be the initial symptoms of ANCA related vasculitis.Such middle ear disease caused by ANCA associated vasculitis has recently been defined as OMAAV.Otologists should be aware of OMAAV diagnose guideline in order to achieve early diagnose of ANCA related vasculitis.

关 键 词：抗中性粒细胞胞浆抗体 ANCA相关血管炎 ANCA相关血管炎性中耳炎 分泌性中耳炎 周围性面瘫 

分 类 号：R764.21[医药卫生—耳鼻咽喉科]