中性粒细胞胞质抗体阴性肉芽肿性多血管炎1例  

ANCA-negative granulomatosis with polyangiitis: a case report

作　　者：孙翠宏 李敏[2] 李秋钰 梁瀛[1] 孙永昌[1] 朱翔[2] Sun Cuihong;Li Min;Li Qiuyu;Liang Ying;Sun Yongchang;Zhu Xiang(Department of Pulmonary and Critical Care Medicine,Peking University Third Hospital,Beijing 100191,China;Department of Pathology,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]北京大学第三医院呼吸与危重医学科,北京100191 [2]北京大学第三医院病理科,北京100191

出　　处：《中华结核和呼吸杂志》2024年第3期240-244,共5页Chinese Journal of Tuberculosis and Respiratory Diseases

摘　　要：本文报道1例以肺部多发结节伴空洞为主要特征的老年男性病例。患者为73岁老年男性,主因"干咳伴气短3个月"入院,胸部CT示双肺多发不规则团块、结节、斑片影,伴空洞形成,同时合并贫血、肾功能不全,经验性抗感染、抗结核治疗后肺部结节进展、空洞增大。多次检测血ANCA均为阴性。支气管镜下对右肺中叶病变行黏膜活检,可见小片状坏死、局灶肉芽肿结构形成以及血管炎表现,弹力纤维染色在坏死灶中可见残存的血管壁结构。临床诊断ANCA阴性肉芽肿性多血管炎,给予糖皮质激素及环磷酰胺治疗后病灶缩小。We reported a case of 73-year-old male with multiple pulmonary nodules and cavities.The patient was admitted with a chief complaint of"dry cough with shortness of breath for 3 months".Chest CT showed multiple irregular masses,nodules,and patchy lesions in both lungs,accompanied by the formation of cavities.He also had anemia and renal dysfunction.Despite given empirical anti-infective and anti-tuberculosis treatments,the pulmonary nodules progressed,and the cavities enlarged.Anti-neutrophil cytoplasmic antibodies(ANCA)were negative twice.Bronchoscopic biopsy was performed.The mucosal pathology of the right middle lobe lesion showed little necrosis,focal granulomatous structure formation,and relevant vasculitis and remaining vessel wall structure in the necrosis lesions by elastic fiber staining.A clinical diagnosis of ANCA-negative necrotizing granulomatous polyangiitis was made and the patient was treated with glucocorticoids and cyclophosphamide.The nodules and cavities shrank,and some lesions were absorbed.

关 键 词：空洞形成 片状坏死 男性病例 支气管镜 肺部结节 坏死灶 肾功能不全 糖皮质激素 

分 类 号：R563[医药卫生—呼吸系统]