慢性Q热导致Ⅲ型冷球蛋白血症及肾小球肾炎  

TypeⅢcryoglobulinemia and glomerulonephritis induced by chronic Q fever:a case report

作　　者：胡蓉蓉 于晓晨 郭伏平 王颖 郑可 陈丽萌 HU Rongrong;YU Xiaochen;GUO Fuping;WANG Ying;ZHENG Ke;CHEN Limeng(Department of Nephrology,State Key Laboratory of Complex Severe and Rare Diseases,Peking Union Medical College Hospital,Chinese Academy of Medical Science and Peking Union Medical College,Beijing 100730,China;Department of Infectious Diseases,Peking Union Medical College Hospital,Chinese Academy of Medical Science and Peking Union Medical College,Beijing 100730,China)

机构地区：[1]中国医学科学院、北京协和医学院、北京协和医院肾内科疑难重症及罕见病、国家重点实验室(北京协和医院),北京100730 [2]中国医学科学院、北京协和医学院、北京协和医院感染内科,北京100730

出　　处：《肾脏病与透析肾移植杂志》2025年第1期96-100,共5页Chinese Journal of Nephrology,Dialysis & Transplantation

基　　金：中央高水平医院临床科研业务(2022-PUMCH-B-019)。

摘　　要：中年男性患者,风湿性心脏病行主动脉瓣置换术后3年,出现皮肤紫癜、乏力,蛋白尿及镜下血尿,血清肌酐升高,免疫抑制治疗效果不佳,进一步检查发现免疫球蛋白、炎症指标明显升高、Ⅲ型冷球蛋白血症,因间断发热行外周血宏基因组二代测序提示贝纳柯克斯体,诊断慢性Q热,予米诺环素联合羟氯喹治疗后好转。A middle-aged male patient developed skin purpura,fatigue,proteinuria,microscopic hematuria,renal function impairment with remarkable past medical history of aortic valve replacement.Despite initial treatment with immunosuppressive agents,his symptoms persisted.Subsequent investigations revealed elevated immunoglobulin levels,inflammatory markers,and a positive result for typeⅢcryoglobulin.Further evaluation,prompted by recurrent low-grade fever,included peripheral blood metagenomic next-generation sequencing(NGS),which detected Coxiella burnetii.Chronic Q-fever was diagnosed.Treatment with minocycline and hydroxychloroquine resulted in significant improvement in his condition and renal function.

关 键 词：慢性Q热 肾小球肾炎 冷球蛋白血症 感染性心内膜炎 

分 类 号：R692.31[医药卫生—泌尿科学] R513.4[医药卫生—外科学]