"显微镜下多血管炎"让人防不胜防,小心中招!

2021-08-20 黄闰月 风湿闰月说

什么是显微镜下多血管炎

什么是显微镜下多血管炎

显微镜下多血管炎是一种主要累积小血管的系统性坏死性血管炎疾病,常常侵犯肾脏、皮肤和肺的等脏器的小血管;

因大部分患者可检测出抗中性粒细胞胞浆抗体,也就是我们常说的ANCA抗体阳性,故此病又归属于ANCA相关性血管炎。

从本病发病率来看,以男性发病较多,男女比例2:1,一般发病年龄约50~60岁左右。

显微镜下多血管炎有哪些临床表现?

此病可以为超急性起病,表现为快速进展性的肾小球肾炎和肺出血,当然也可以非常隐匿,不易察觉,在数年间可见皮肤紫癜、轻度的肾损害等。

典型的临床表现为肺—肾—皮肤,与该病常累及的血管部位相一致;

1肺部损害

超过一半的患者存在肺部损害,多数患者急性起病,最严重的肺部损害是弥漫性肺泡出血;

2肾脏损害

肾脏受累是本病最常见的临床表现,多数患者可出现蛋白尿,血尿,各种管型尿,水肿,肾性高血压;

3皮肤表现

以紫癫及可触及的充血性斑丘疹多件,严重者见坏疽、肢端缺血等。

4其他表现

如神经系统可出现多发性神经炎,消化系统可表现为消化道出血、胰腺炎以及由肠道缺血引起的腹痛。

显微镜下多血管炎需做哪些检查?

1---常规检查方面

反应急性期炎症的指标如血沉、c反应蛋白升高,部分患者可有贫血、白细胞和血小板增多;

2---免疫学方面

80%的患者可出现ANCA抗体阳性,这是显微镜下多血管炎的重要诊断依据,也是监测病情复发的重要血清指标,其滴度通常与血管炎活动度相关。

3---影像学检查方面

胸部X线检查在早期可发现无特征性肺部浸润影或小泡状浸润影;病理检查方面,以肾脏病理检查多见,病理特征为小血管的节段性纤维素样坏死、血栓、新月体形成。

显微镜下多血管炎如何治疗?

该病治疗可以分为三个阶段,即诱导期、维持缓解期和治疗复发。

诱导期和维持缓解期一般使用糖皮质激素与免疫抑制剂相结合的方案,免疫抑制剂可选用环磷酰胺、硫唑嘌呤、甲氨喋呤、霉酚酸酯。

同时,丙种球蛋白,血浆置换,生物制剂也可用于治疗方案当中,具体视病情情况而定。

若此病累及肾致肾功能衰竭,则需要依赖维持性血液透析或者进行肾移植,但移植过后仍有少数患者复发。

显微镜下多血管炎的预后情况如何?

经治疗后90%患者病情可以改善,75%的患者能得到完全缓解,约有30%的患者在1-2年复发。

因此在治疗过程中需要病人密切配合临床医生进行病情的监测以达到病情缓解的目的。

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  2. [GetPortalCommentsPageByObjectIdResponse(id=1744033, encodeId=701f1e4403385, content=<a href='/topic/show?id=414659e35b4' target=_blank style='color:#2F92EE;'>#显微镜下多血管炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=59735, encryptionId=414659e35b4, topicName=显微镜下多血管炎)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d35535252845, createdName=bnurmamat, createdTime=Sat Jan 01 20:22:45 CST 2022, time=2022-01-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1893807, encodeId=380d189380ec9, content=<a href='/topic/show?id=ab2159e343a' target=_blank style='color:#2F92EE;'>#显微镜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=59734, encryptionId=ab2159e343a, topicName=显微镜)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=54f9127, createdName=tulenzi, createdTime=Sun Jun 12 14:22:45 CST 2022, time=2022-06-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1077128, encodeId=1bc110e71280b, content=挺好的,但是感觉不够细致, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8cfb6166872, createdName=ms6000000739017547, createdTime=Sun Dec 05 18:53:09 CST 2021, time=2021-12-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1263260, encodeId=71991263260b2, content=<a href='/topic/show?id=581e8968859' target=_blank style='color:#2F92EE;'>#血管炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89688, encryptionId=581e8968859, topicName=血管炎)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=909c71, createdName=shijzhiewnjhch, createdTime=Sun Aug 22 02:22:45 CST 2021, time=2021-08-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1545898, encodeId=08291545898af, content=<a href='/topic/show?id=f5e743450aa' target=_blank style='color:#2F92EE;'>#多血管炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=43450, encryptionId=f5e743450aa, topicName=多血管炎)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0b6013824614, createdName=12498bf3m29暂无昵称, createdTime=Sun Aug 22 02:22:45 CST 2021, time=2021-08-22, status=1, ipAttribution=)]
    2022-06-12 tulenzi
  3. [GetPortalCommentsPageByObjectIdResponse(id=1744033, encodeId=701f1e4403385, content=<a href='/topic/show?id=414659e35b4' target=_blank style='color:#2F92EE;'>#显微镜下多血管炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=59735, encryptionId=414659e35b4, topicName=显微镜下多血管炎)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d35535252845, createdName=bnurmamat, createdTime=Sat Jan 01 20:22:45 CST 2022, time=2022-01-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1893807, encodeId=380d189380ec9, content=<a href='/topic/show?id=ab2159e343a' target=_blank style='color:#2F92EE;'>#显微镜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=59734, encryptionId=ab2159e343a, topicName=显微镜)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=54f9127, createdName=tulenzi, createdTime=Sun Jun 12 14:22:45 CST 2022, time=2022-06-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1077128, encodeId=1bc110e71280b, content=挺好的,但是感觉不够细致, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8cfb6166872, createdName=ms6000000739017547, createdTime=Sun Dec 05 18:53:09 CST 2021, time=2021-12-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1263260, encodeId=71991263260b2, content=<a href='/topic/show?id=581e8968859' target=_blank style='color:#2F92EE;'>#血管炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89688, encryptionId=581e8968859, topicName=血管炎)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=909c71, createdName=shijzhiewnjhch, createdTime=Sun Aug 22 02:22:45 CST 2021, time=2021-08-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1545898, encodeId=08291545898af, content=<a href='/topic/show?id=f5e743450aa' target=_blank style='color:#2F92EE;'>#多血管炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=43450, encryptionId=f5e743450aa, topicName=多血管炎)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0b6013824614, createdName=12498bf3m29暂无昵称, createdTime=Sun Aug 22 02:22:45 CST 2021, time=2021-08-22, status=1, ipAttribution=)]
    2021-12-05 ms6000000739017547

    挺好的,但是感觉不够细致

    0

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