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作 者:张宁 武娟 孙晓红 康琳 袁灵 杨华夏[4] 罗玲[5] 芦波[6] 周翔[7] 张文[4] ZHANG Ning;WU Juan;SUN Xiaohong;KANG Lin;YUAN Ling;YANG Huaxia;LUO Ling;LU Bo;ZHOU Xiang;ZHANG Wen(Department of Geriatrics,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China;Department of Internal Medicine,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China;Department of Radiology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China;Department of Rheumatology and Clinical Immunology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China;Department of Infectious Diseases,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China;Department of Gastroenterology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China;Department of Endocrinology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China)
机构地区:[1]中国医学科学院北京协和医院老年医学科,北京100730 [2]中国医学科学院北京协和医院内科学系,北京100730 [3]中国医学科学院北京协和医院放射科,北京100730 [4]中国医学科学院北京协和医院风湿免疫科,北京100730 [5]中国医学科学院北京协和医院感染内科,北京100730 [6]中国医学科学院北京协和医院消化内科,北京100730 [7]中国医学科学院北京协和医院内分泌科,北京100730
出 处:《协和医学杂志》2023年第4期889-894,共6页Medical Journal of Peking Union Medical College Hospital
基 金:中央高水平医院临床科研专项(2022-PUMCH-B-132)。
摘 要:本文报道一例因“纳差2个月,皮肤及巩膜黄染1个月”就诊于北京协和医院老年医学科的患者。患者血清总胆红素、直接胆红素、血糖显著升高,血清IgG4水平升高近3倍,腹部影像学检查示胰腺弥漫性病变,胆总管胰内段明显狭窄,肝总管、左右肝管及分支增厚伴异常强化。患者病程中血糖亦显著升高,营养评估提示合并营养不良。由于患者高龄且多病共存,经多学科讨论后,给予中等剂量甲泼尼龙并快速减量,联合小剂量吗替麦考酚酯治疗,最终患者胆红素水平显著下降,黄疸基本消退,体质量恢复至起病前,躯体功能改善。在该例患者的诊疗过程中,多学科团队共同参与,逐步厘清病因,成功救治该患者,体现了多学科协作在老年疑难病诊疗中的重要作用。In this paper,we report an elderly patient who had been experiencing poor appetite for one month and yellowing of the skin and sclera for two months before visiting the Department of Geriatrics at Peking Union Medical College Hospital.The patients blood tests revealed significantly elevated levels of serum total bili⁃rubin,direct bilirubin,and blood sugar.The serum IgG4 level nearly tripled.Abdominal imaging examinations re⁃vealed diffuse pancreatic lesions,narrowing of the intrapancreatic segment of the common bile duct,and thicken⁃ing and marked enhancement of the common hepatic duct,left and right hepatic ducts,and branches.Blood glu⁃cose was also significantly elevated during the course of the disease.Moreover,nutritional assessment found that the patient was malnourished.After multidisciplinary discussion,a medium dose of oral methylprednisolone was prescribed to the patient due to his advanced age and multiple chronic conditions.The dose was then quickly re⁃duced while the patient simultaneously received low-dose mycophenolate mofetil(MMF)treatment.As a result,the patients bilirubin level significantly decreased,jaundice subsided,and his body weight returned to normal with improved physical function.Throughout the diagnosis and treatment process,a multidisciplinary team actively participated in discussions and gradually identified the underlying cause.This exemplifies the crucial role of inter⁃disciplinary collaboration in effectively diagnosing and treating complex illnesses in elderly patients.
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