以分泌性中耳炎为首诊症状的ANCA相关小血管炎的临床误诊2例
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摘要
回顾性分析白求恩国际和平医院诊治的2例合并分泌性中耳炎的抗中性粒细胞胞质抗体(antineutrophil cytoplasmic antibody,ANCA)相关小血管炎的临床资料及随访资料。该2例患者早期均出现耳闷、听力下降等分泌性中耳炎症状,完善血清免疫学检查后确诊为ANCA相关小血管炎,积极行激素及免疫治疗,单纯针对中耳炎的治疗效果不良。ANCA相关小血管炎患者临床表现复杂多样,少数病例以分泌性中耳炎或鼻窦炎为首发症状,极易误诊,诊断时不能局限于专科疾病,需结合特异性实验室检查确诊。早期确诊并给予激素及免疫治疗方案,有利于提高疗效和预防疾病进展。
The clinical data and follow-up data of two cases of antineutrophil cytoplasmic antibody(ANCA)-associated vasculitis accompanied with secretory otitis media in our hospital were retrospectively analyzed. The two cases all presented symptoms of secretory otitis media, such as ear fullness and hearing loss in the early stage. After completing serum immunological examination, they were diagnosed as ANCA-associated vasculitis. Hormone and immunotherapy should be carried out actively, and treatment of otitis media alone is not effective. The clinical manifestations of ANCA-associated vasculitis patients are complex and diverse. In a few cases, secretory otitis media or rhinosinusitis are the first symptom, which is easy to be misdiagnosed. Diagnosis should not be limited to specific diseases, but can be confirmed by specific laboratory examination. Early diagnosis and hormone and immunotherapy regimen are beneficial for improving curative effect and preventing disease progression.
The clinical data and follow-up data of two cases of antineutrophil cytoplasmic antibody(ANCA)-associated vasculitis accompanied with secretory otitis media in our hospital were retrospectively analyzed. The two cases all presented symptoms of secretory otitis media, such as ear fullness and hearing loss in the early stage. After completing serum immunological examination, they were diagnosed as ANCA-associated vasculitis. Hormone and immunotherapy should be carried out actively, and treatment of otitis media alone is not effective. The clinical manifestations of ANCA-associated vasculitis patients are complex and diverse. In a few cases, secretory otitis media or rhinosinusitis are the first symptom, which is easy to be misdiagnosed. Diagnosis should not be limited to specific diseases, but can be confirmed by specific laboratory examination. Early diagnosis and hormone and immunotherapy regimen are beneficial for improving curative effect and preventing disease progression.
引文
1.Baldwin C,Carette S,Pagnoux C.Linking classification and therapeutic management of vasculitides[J].Arthritis Res Ther,2015,17:138.
2.Pagnoux C.Updates in ANCA-associated vasculitis[J].Eur JRheumatol,2016,3(3):122-133.
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5.Komocsi A,Lamprecht P,Csernok E,et al.Peripheral blood and granuloma CD4(+)CD28(-)T cells are a major source of interferon-gamma and tumor necrosis factor-alpha in Wegener’s granulomatosis[J].Am J Pathol,2002,160(5):1717-1724.
6.陈旻.原发性小血管炎发病机制研究进展[J].中华肾病研究电子杂志,2014,3(6):13-19.CHEN Min.Progress of research on pathogenesis of primary small vasculitis[J].Chinese Journal of Kidney Disease Investigation.Electronic Edition,2014,3(6):13-19.
7.冯勃,张延平,韩东一.原发性小血管炎的耳科学表现[J].中华耳科学杂志,2009,7(4):296-299.FENG Bo,ZHANG Yanping,HAN Dongyi.Otology manifestations of primary small vasculitis[J].Chinese Journal of Otology,2009,7(4):296-299.
8.Wiik A.Autoantibodies in vasculitis[J].Arthritis Res Ther,2003,5(3):147-152.
9.Gómez-Puerta JA,Bosch X.Anti-neutrophil cytoplasmic antibody pathogenesis in small-vessel vasculitis:an update[J].Am J Pathol,2009,175(5):1790-1798.
10.柳岚岚,吴彼得,连学坚.抗中性粒细胞胞浆抗体相关性小血管炎治疗进展[J].医学理论与实践,2013,26(21):2828-2829.LIU Lanlan,WU Bide,LIAN Xuejian.Development of anti-neutrophil cytoplasmic antibody associated small vasculitis[J].The Journal of Medical Theory and Practice,2013,26(21):2828-2829.
11.尹黎.抗中性粒细胞胞浆抗体相关性血管炎的免疫抑制剂治疗进展[J].检验医学与临床,2013,10(10):1286-1288.YIN Li.Development of immunosuppressive therapy against neutrophil cytoplasmic antibody associated vasculitis[J].Laboratory Medicine and Clinic,2013,10(10):1286-1288.
12.Sanders JS,Slot MC,Stegeman CA.Maintenance therapy for vasculitis associated with antineutrophil cytoplasmic autoantibodies[J].N Engl JMed,2003,349(21):2072-2073.
13.邵永良,周永青,李晓明,等.显微镜下多血管炎并分泌性中耳炎误诊原因分析[J].临床误诊误治,2016,29(2):40-44.SHAO Yongliang,ZHOU Yongqing,LI Xiaoming,et al.Misdiagnosis analysis of microscopic polyangiitis with secretory otitis media[J].Clinical Misdiagnosis&Mistherapy,2016,29(2):40-44.
2.Pagnoux C.Updates in ANCA-associated vasculitis[J].Eur JRheumatol,2016,3(3):122-133.
3.Jennette JC.Overview of the 2012 revised International Chapel Hill consensus conference nomenclature of vasculitides[J].Clin Exp Nephrol,2013,17(5):603-606.
4.Grayson PC,Carmona-Rivera C,Xu L,et al.Neutrophil-related gene expression and low-density granulocytes associated with disease activity and response to treatment in antineutrophil cytoplasmic antibody-associated vasculitis[J].Arthritis Rheumatol,2015,67(7):1922-1932.
5.Komocsi A,Lamprecht P,Csernok E,et al.Peripheral blood and granuloma CD4(+)CD28(-)T cells are a major source of interferon-gamma and tumor necrosis factor-alpha in Wegener’s granulomatosis[J].Am J Pathol,2002,160(5):1717-1724.
6.陈旻.原发性小血管炎发病机制研究进展[J].中华肾病研究电子杂志,2014,3(6):13-19.CHEN Min.Progress of research on pathogenesis of primary small vasculitis[J].Chinese Journal of Kidney Disease Investigation.Electronic Edition,2014,3(6):13-19.
7.冯勃,张延平,韩东一.原发性小血管炎的耳科学表现[J].中华耳科学杂志,2009,7(4):296-299.FENG Bo,ZHANG Yanping,HAN Dongyi.Otology manifestations of primary small vasculitis[J].Chinese Journal of Otology,2009,7(4):296-299.
8.Wiik A.Autoantibodies in vasculitis[J].Arthritis Res Ther,2003,5(3):147-152.
9.Gómez-Puerta JA,Bosch X.Anti-neutrophil cytoplasmic antibody pathogenesis in small-vessel vasculitis:an update[J].Am J Pathol,2009,175(5):1790-1798.
10.柳岚岚,吴彼得,连学坚.抗中性粒细胞胞浆抗体相关性小血管炎治疗进展[J].医学理论与实践,2013,26(21):2828-2829.LIU Lanlan,WU Bide,LIAN Xuejian.Development of anti-neutrophil cytoplasmic antibody associated small vasculitis[J].The Journal of Medical Theory and Practice,2013,26(21):2828-2829.
11.尹黎.抗中性粒细胞胞浆抗体相关性血管炎的免疫抑制剂治疗进展[J].检验医学与临床,2013,10(10):1286-1288.YIN Li.Development of immunosuppressive therapy against neutrophil cytoplasmic antibody associated vasculitis[J].Laboratory Medicine and Clinic,2013,10(10):1286-1288.
12.Sanders JS,Slot MC,Stegeman CA.Maintenance therapy for vasculitis associated with antineutrophil cytoplasmic autoantibodies[J].N Engl JMed,2003,349(21):2072-2073.
13.邵永良,周永青,李晓明,等.显微镜下多血管炎并分泌性中耳炎误诊原因分析[J].临床误诊误治,2016,29(2):40-44.SHAO Yongliang,ZHOU Yongqing,LI Xiaoming,et al.Misdiagnosis analysis of microscopic polyangiitis with secretory otitis media[J].Clinical Misdiagnosis&Mistherapy,2016,29(2):40-44.