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目的提高对显微镜下多血管炎(MPA)的影像学和临床表现的认识。方法对确诊的一例以多叶段肺实变为特征的MPA患者进行回顾性分析。结果患者以咳嗽、咳痰、咯血伴发热1周,心悸、气短2 d入院。临床出现镜下血尿,蛋白尿,心律失常,巩膜炎,耳廓皮肤红肿,贫血,体重下降等多系统损害。血沉明显增快(150 mm/1 h),经多种抗菌素、抗病毒药物等治疗无效。在CT定位下经皮肺穿刺活检提示韦格纳肉芽肿,核周型抗中性粒细胞胞质抗体阳性,诊断为MPA。给予强的松联合环磷酰胺治疗,临床症状明显缓解,实验室指标好转。结论临床中对双肺多叶段实变,伴无法解释的临床多系统损害,经抗炎、抗病毒等治疗无效时,要考虑到MPA,应及时行经肺活检及抗中性粒细胞胞质抗体检查以早期诊断,给予糖皮质激素联合环磷酰胺治疗,疗效佳。
Objective To improve the understanding of the imaging and clinical manifestations of microscopic polyangiitis (MPA). Methods A retrospective analysis was performed on one confirmed case of MPA characterized by multistep lung consolidation. Results Patients with cough, sputum, hemoptysis with fever for 1 week, palpitations, shortness of breath 2 d admission. Clinical appearance of microscopic hematuria, proteinuria, arrhythmia, scleritis, ear skin irritation, anemia, weight loss and other system damage. Erythrocyte significantly faster (150 mm / 1 h), after a variety of antibiotics, antiviral drugs such as treatment ineffective. Percutaneous lung biopsy under CT location suggested Wegener’s granulomatosis with perinuclear anti-neutrophil cytoplasmic antibody positive and MPA diagnosis. Given prednisone combined cyclophosphamide treatment, clinical symptoms were significantly alleviated, laboratory indicators improved. Conclusions Clinical multi-lobar fianles of solidification, with unexplained clinical multi-system damage, anti-inflammatory, antiviral therapy ineffective, taking into account the MPA, should be timely through the lung biopsy and anti-neutrophil cytoplasm Antibody examination to early diagnosis, given glucocorticoid combined with cyclophosphamide treatment, good effect.