迁延不愈的“肺炎”1例  

A case report of prolonged pneumonia

作　　者：梁瑞[1] 张竹 刘东 王金志 黄强 谢万木 翟振国 Liang Rui;Zhang Zhu;Liu Dong;Wang Jinzhi;Huang Qiang;Xie Wanmu;Zhai Zhenguo(Beijing University of Chinese Medicine China-Japan Friendship School of Clinical Medicine,National Center for Respiratory Medicine,State Key Laboratory of Respiratory Health and Multimorbidity,National Clinical Research Center for Respiratory Diseases,Institute of Respiratory Medicine,Chinese Academy of Medical Sciences,Department of Pulmonary and Critical Care Medicine,Center of Respiratory Medicine,China-Japan Friendship Hospital,Beijing 100029,China;National Center for Respiratory Medicine,State Key Laboratory of Respiratory Health and Multimorbidity,National Clinical Research Center for Respiratory Diseases,Institute of Respiratory Medicine,Chinese Academy of Medical Sciences,Department of Pulmonary and Critical Care Medicine,Center of Respiratory Medicine,China-Japan Friendship Hospital,Beijing 100029,China;Peking University China-Japan Friendship School of Clinical Medicine,National Center for Respiratory Medicine,State Key Laboratory of Respiratory Health and Multimorbidity,National Clinical Research Center for Respiratory Diseases,Institute of Respiratory Medicine,Chinese Academy of Medical Sciences,Department of Pulmonary and Critical Care Medicine,Center of Respiratory Medicine,China-Japan Friendship Hospital,Beijing 100029,China;Department of Pulmonary and Critical Care Medicine,The First Affiliated Hospital of Nanchang University,Department of Pulmonary and Critical Care Medicine,National Regional Center for Respiratory Medicine,Jiangxi Hospital of China-Japan Friendship Hospital,Nanchang 330000,China)

机构地区：[1]北京中医药大学中日友好临床医学院,国家呼吸医学中心,呼吸和共病全国重点实验室,国家呼吸疾病临床研究中心,中国医学科学院呼吸病学研究院,中日友好医院呼吸中心呼吸与危重症医学科,北京100029 [2]国家呼吸医学中心,呼吸和共病全国重点实验室,国家呼吸疾病临床研究中心,中国医学科学院呼吸病学研究院,中日友好医院呼吸中心呼吸与危重症医学科,北京100029 [3]北京大学中日友好临床医学院,国家呼吸医学中心,呼吸和共病全国重点实验室,国家呼吸疾病临床研究中心,中国医学科学院呼吸病学研究院,中日友好医院呼吸中心呼吸与危重症医学科,北京100029 [4]南昌大学第一附属医院,呼吸与危重症医学科,南昌国家区域医疗中心,中日友好江西医院,南昌330000

出　　处：《中华结核和呼吸杂志》2024年第9期845-850,共6页Chinese Journal of Tuberculosis and Respiratory Diseases

基　　金：中央高水平医院临床科研业务费资助(2022-NHLHCRF-LX-01-0203);中国医学科学院临床与转化医学研究专项(2023-I2M-C&T-A-014);中央高水平医院临床科研业务费资助(2023-NHLHCRF-YGJH-03)。

摘　　要：大动脉炎肺动脉受累(Takayasu′s arteritis-pulmonary artery involvement,TA-PAI)是一种累及肺动脉及其分支的慢性进行性炎性疾病,多数患者早期表现为发热、呼吸困难、胸痛等非特异性呼吸系统症状,误诊率较高。目前TA-PAI的诊断主要依据大动脉炎的诊断标准及肺动脉受累的影像学证据,但肺动脉受累未被纳入常用的大动脉炎诊断标准,导致TA-PAI尤其是孤立性肺动脉受累诊断率可能被严重低估。本文报道1例26岁的女性患者,反复胸痛伴发热,外院诊断为“肺炎”,治疗4个月未见明显好转,后因咯血发作于我院就诊,最终确诊为大动脉炎肺动脉受累,予激素、免疫抑制剂以及肺血管介入治疗后病情稳定。通过分析该病例的临床特点及诊疗思路,并复习相关文献,提高临床医生对大动脉炎肺动脉受累的认识。Takayasu′s arteritis-pulmonary artery involvement(TA-PAI)is a chronic,progressive,inflammatory disease affecting the pulmonary artery and its branches.Patients typically present with non-specific respiratory symptoms,such as fever,dyspnea,and chest pain,leading to a high rate of misdiagnosis.The diagnosis of TA-PAI is currently based on the diagnostic criteria of aortitis and imaging evidence of pulmonary artery involvement.However,pulmonary artery involvement is not typically included in the diagnostic criteria for aortitis,which may lead to a significant underestimation of the diagnostic rate of TA-PAI,particularly in cases where pulmonary artery involvement is the only manifestation.This article reports the case of a 26-year-old female patient who presented with recurrent chest pain and fever.She was initially diagnosed with pneumonia in a foreign hospital but did not show significant improvement after four months of treatment.Eventually,she was diagnosed with pulmonary artery involvement in aortitis and was stabilized with hormones,immunosuppressive drugs,and pulmonary vascular intervention.By analyzing the clinical features and diagnostic and therapeutic approaches of this case,and reviewing the relevant literature,clinicians can improve their understanding of TA-PAI.

关 键 词：大动脉炎 呼吸系统症状 血管介入治疗 诊断标准 诊疗思路 临床医生 胸痛 呼吸困难 

分 类 号：R563[医药卫生—呼吸系统]