儿童显微镜下多血管炎2例并文献复习

发布时间：2018-05-31 10:47

本文选题：显微镜下多血管炎 + 儿童　；参考：《中国实用儿科杂志》2017年05期

【摘要】：目的通过复习儿童显微镜下多血管炎(MPA)的临床及实验室特点、诊断及治疗方法,以期提高医师对该病的认识。方法对2009年12月至2015年1月中国医科大学附属第一医院儿科诊治的2例儿童MPA的临床和病理资料进行回顾性分析。结果2例均为女性,年龄分别为12、14岁。均以贫血为首发症状,伴有间断血尿和(或)蛋白尿,按缺铁性贫血治疗无好转。例1发病半年后贫血加重,并出现咳嗽、咳痰带血、伴有肉眼血尿和蛋白尿,肺CT显示肺泡内出血。例2病初同时患有桥本甲状腺炎,口服优甲乐治疗,8个月后出现膝关节间断肿痛,活动受限,膝关节磁共振(MR)提示滑膜炎,同时血尿、蛋白尿加重。2例p-ANCA(+)、c-ANCA(-),其他自身抗体、补体、病毒抗体系列、肺炎支原体抗体、肝炎病毒标识物均阴性。2例肾活检结果均为寡免疫复合物新月体肾炎。结论MPA病情进展隐匿,确诊时多为晚期,治疗主要应用糖皮质激素和免疫抑制剂,预后依赖于早期诊断和早期治疗。
[Abstract]:Objective to review the clinical and laboratory characteristics, diagnosis and treatment of polyvasculitis in children. Methods from December 2009 to January 2015, the clinical and pathological data of 2 cases of pediatric MPA in the first affiliated Hospital of China Medical University were retrospectively analyzed. Results the two cases were all female, their ages were 1214 years old respectively. Anemia was the first symptom with intermittent hematuria and / or proteinuria. Case 1, anemia aggravated half a year after onset, cough, sputum with blood, accompanied by gross hematuria and proteinuria, pulmonary CT showed intraalveolar hemorrhage. Case 2 was treated with Hashimoto's thyroiditis at the beginning of the disease. After 8 months of treatment, intermittent swelling and pain of the knee joint, limited movement, MRR of the knee indicated synovitis, hematuria and proteinuria in 2 patients with p-ANCA (c-ANCA-P), other autoantibodies. Complement, virus antibody series, mycoplasma pneumoniae antibody and hepatitis virus marker were all negative. 2 cases of renal biopsy showed oligoimmune complex crescene nephritis. Conclusion the progress of MPA is concealed and the diagnosis is late. Glucocorticoids and immunosuppressants are mainly used in the treatment. The prognosis depends on the early diagnosis and treatment.
【作者单位】：中国医科大学附属第一医院儿科;
【基金】：沈阳市科技计划项目(F16-206-9-44)
【分类号】：R725.9

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