误诊为肺结核瘤的ANCA相关性血管炎临床分析  

Analysis of ANCA⁃associated Vasculitis Misdiagnosed as Pulmonary Tuber⁃culoma

作　　者：胡以恒 伊力努尔·哈力甫[1] 康晓静[1] 沈晓峰[2] HU Yiheng;ILINUR Khalif;KANG Xiaojing;SHEN Xiaofeng(Department of Dermatology and Venereology,People's Hospital of Xinjiang Uygur Autonomous Region,Xinjiang Clinical Research Center for Dermatology,Xinjiang Key Laboratory of Dermatology,Urumqi 830001,China;Department of Derma-tology,Fifth Affiliated Hospital of Xinjiang Medical University,Urumqi 830011,China)

机构地区：[1]新疆维吾尔自治区人民医院皮肤性病科新疆皮肤病临床医学研究中心新疆皮肤病研究重点实验室,乌鲁木齐830001 [2]新疆医科大学第五附属医院皮肤科,乌鲁木齐830011

出　　处：《临床误诊误治》2024年第4期16-19,共4页Clinical Misdiagnosis & Mistherapy

基　　金：新疆维吾尔自治区“天山英才”培养计划(2022TSYCLJ0025)。

摘　　要：目的探讨抗中性粒细胞胞质抗体(ANCA)相关性血管炎的误诊原因及防范措施。方法回顾分析1例曾误诊的ANCA相关性血管炎的临床资料。结果本例因下肢红疹伴溃疡入院。曾行“鼻窦炎”手术,术前筛查发现肺部肿物行“肺部肿物切除术”,术后病理示肺结核瘤,抗结核治疗无效。入院后结合患者多系统受累表现及实验室、肾穿刺病理检查等诊断为ANCA相关性血管炎,给予糖皮质激素及调节免疫等治疗,症状缓解。结论ANCA相关性血管炎临床表现多样且不典型,易误诊。临床中应对疑似病例尽早行相关医技检查。Objective To explore the causes of misdiagnosis of anti⁃neutrophil cytoplasmic antibodies(ANCA)⁃associatedvasculitis and the preventive measures.Methods The clinical data of 1 patient with ANCA⁃associated vasculitis misdiagnosed were retrospectively analyzed.Results The patient was admitted to the hospital due to red rash of lower extrem⁃ity with ulcer.Operation for sinusitis had been performed in other hospitals,and pulmonary mass resection was performed in another hospital because pulmonary mass had been found during preoperative screening.Postoperative pathology revealed pul⁃monary tuberculoma,and the treatment was ineffective after anti⁃tuberculosis therapy.After admission,the patient was diag⁃nosed with ANCA⁃associated vasculitis based on the manifestations of multi⁃system involvement,laboratory examination and pathological examination of renal puncture.The symptoms were relieved by glucocorticoid and modulated immunotherapy.Conclusion The clinical manifestations of ANCA⁃associated vasculitis are diverse and atypical,which,therefore,is more likely to lead to misdiagnosis.In clinical practice,relevant medical examination should be performed as soon as possible in suspected cases.

关 键 词：抗中性粒细胞胞质抗体相关性血管炎 误诊 肺结核瘤 抗结核药 抗体 抗核 抗体 抗中性白细胞胞质 抗蛋白酶3抗体 糖皮质激素类 

分 类 号：R543[医药卫生—心血管疾病]