NEJM:肉芽肿血管炎的胃肠道并发症-案例报道

2016-06-02 MedSci MedSci原创

http://www.nejm.org/doi/full/10.1056/NEJMicm1511069?query=featured_clinical-practice

患者男性,48岁,既往患有肉芽肿血管炎病史。

 
据了解,该患者因抗中性粒细胞胞浆抗体阳性,在过去的7年里一致服用硫唑嘌呤。

入院检查时发现其血肌酐水平为9.5mg/dl(840μmol/l;正常值为0.5-1.2mg/dl[ 40-110μmol/l])。尿蛋白水平为++。

入院几天后,该患者突发严重的腹痛,症状与腹膜炎一致。

行CT血管造影检查,高度提示远端十二指肠和空肠肠壁缺血(如图A,白色箭头)与周围脂肪间隙、肠系膜水肿(黄色箭头),在腹部和盆腔存在游离液体(红色箭头)。

随后,该患者立即被送往手术室行腹腔镜下探查术,术中发现有40厘米的出血性肠段远端Treitz韧带以及腹腔积血(如图B与图C所示)。由于梗阻的出血性肠段尚有主动蠕动的功能,因此没有进行肠段切除

术后,会诊医师认为这可能是肉芽肿血管炎导致的肠壁血管炎。术后应用肝素进行抗凝治疗。

两天后,患者表现出轻微的腹部疼痛。但血肌酐水平持续升高,同时肾功能迅速恶化,进展为终末期肾衰竭,需每周行血液透析治疗三次。另外,还应用咪唑硫嘌呤药物辅助治疗,然而病情没有任何好转的迹象。

在随后的9个月的随访中,该患者表示再没有出现腹痛以及肉芽肿血管炎的相关性症状。由于其肾功能衰竭,因此他必须接受长期的血液透析治疗。 

原始出处:

Hamzeh M. Halawani, M.D., and Mohamed Khalife, M.D. Gastrointestinal Complication of Granulomatosis with Polyangiitis N Engl J Med 2016; 374:2159June 2, 2016

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    2016-10-08 丁鹏鹏
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