误诊为肺结核的ANCA相关性血管炎分析  

Analysis of ANCA-associated Vasculitis Misdiagnosed as Pulmonary Tuberculosis

作　　者：何蓉会 黄琼 李双良 谢永琼 任崇松 HE Ronghui;HUANG Qiong;LI Shuangliang;XIE Yongqiong;REN Chongsong(Department of Infectious Diseases,Nanchong Central Hospital,Nanchong,Sichuan 637000,China)

机构地区：[1]南充市中心医院川北医学院第二临床医学院感染病科,四川南充637000

出　　处：《临床误诊误治》2024年第2期13-17,共5页Clinical Misdiagnosis & Mistherapy

基　　金：四川省基卫项目(SWFZ20-C-084、SWFZ22-Y-17)。

摘　　要：目的探讨抗中性粒细胞胞浆抗体(ANCA)相关性血管炎临床特征,分析其误诊原因。方法回顾性分析2021年7月—2022年7月收治的ANCA相关性血管炎误诊为肺结核3例的临床资料。结果1例以咳嗽、咯血、气促就诊,1例以咯血就诊,1例以咳嗽、呼吸困难就诊,3例均有肺部受累,均被误诊为肺结核,误诊时间4~29个月。行ANCA谱检测确诊为ANCA相关性血管炎。1例经糖皮质激素治疗后病情缓解;2例未使用糖皮质激素,其中1例失访,1例病情恶化死亡。结论ANCA相关性血管炎临床表现缺乏特异性,临床医生应警惕该病,尽早完善ANCA谱检测,以减少漏诊误诊。Objective To investigate the clinical features of anti-neutrophil cytoplasmic antibody(ANCA)-associated vasculitis and to analyze the causes of misdiagnosis.Methods The clinical data of 3 patients with misdiagnosed ANCA-associated vasculitis as pulmonary tuberculosis admitted from July 2021 to July 2022 were retrospectively analyzed.Results One patient presented with cough,hemoptysis,and shortness of breath,one with hemoptysis,and one with cough and dyspnea.All three patients had lung involvement and were misdiagnosed as pulmonary tuberculosis,and the misdiagnosis lasted 4-29 months.ANCA-associated vasculitis was confirmed by ANCA profile.One patient was relieved after treatment with glucocorticoids,and 2 patients did not use glucocorticoids,of whom one patient was lost to follow-up and one died after deterioration.Conclusion The clinical manifestations of ANCA-associated vasculitis lack specificity,and clinicians should be alert to the disease and improve ANCA profile testing as soon as possible to reduce missed diagnosis and misdiagnosis.

关 键 词：抗中性粒细胞胞浆抗体相关性血管炎 误诊 肺结核 咯血 血尿 抗肾小球基底膜抗体 抗蛋白酶3抗体IgG型 糖皮质激素类 

分 类 号：R543[医药卫生—心血管疾病]