2022 年第 2 期 第 17 卷

抗中性粒细胞胞质抗体相关性血管炎合并肺泡出血1例

A case of antineutrophil cytoplasmic antibody-associated vasculitis combined with alveola hemorrhage

作者：杨洁邢西迁田迎春曹兵何建林

英文作者：Yang Jie Xing Xiqian Tian Yingchun Cao Bing He Jianlin

单位：云南大学附属医院呼吸与危重症医学科，昆明650102

英文单位：Department of Respiratory and Critical Care Medicine Affiliated Hospital of Yunnan University Kunming 650102 China

关键词：抗中性粒细胞胞质抗体相关性血管炎；肺泡出血；病例报告

英文关键词：Antineutrophilcytoplasmicantibody-associatedvasculitis;Alveolahemorrhage;Casereport 

• 摘要：

• 1例78岁男性患者因“咳嗽、咳痰10年，再发加重伴咯血1周”收入院，胸部CT检查示双肺多发间质性病变，并右肺下叶间质性肺炎。经抗中性粒细胞胞质抗体（ANCA）检查示核周型ANCA阳性，抗髓过氧化物酶抗体阳性。完善血常规、痰培养、胸部影像学等检查，明确诊断为ANCA相关性血管炎合并肺泡出血。予激素、抗感染、血浆置换等治疗后患者病情未见好转，最终抢救无效死亡。分析患者在本院治疗经过发现，1年前患者胸部X线片即出现双肺间质性改变，而后胸部CT示磨玻璃影和网格状影，但患者及家属拒绝进一步检查及治疗，ANCA相关性血管炎临床较为少见，症状不典型，容易漏诊。

• A 78 years old male patient was admitted to the hospital because of "cough and expectoration for 10 years, recurrence and hemoptysis for 1 week". Chest CT showed multiple interstitial lesions in both lungs and interstitial pneumonia in the lower lobe of the right lung. Antineutrophil cytoplasmic antibodies (ANCA) showed that perinuclear ANCA and anti-myeloperoxidase antibody were positive. ANCA-associated vasculitis with alveolar hemorrhage was clearly diagnosed after blood routine, sputum culture, chest imaging and other examinations. After the treatment of hormone, anti-infection and plasmapheresis, the patient′s condition did not improve, and finally the rescue was ineffective and died. Analyzing the treatment of the patient in our hospital, it was found that the interstitial changes of both lungs appeared on the chest X-ray film of the patient one year ago, and then the chest CT showed ground glass shadow and grid shadow, but the patient and his family refused further examination and treatment. ANCA-associated vasculitis is rare and atypical in clinic. It was easy to miss diagnosis.  alibri;mso-hansi-theme-font:minor-latin'>缪巍1