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Wegener's Granulomatosis Combined with Pulmonary Tuberculosis: Report of 8 Cases and Literature Review
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摘要:
目的 分析韦格纳肉芽肿合并肺结核的临床特征。 方法 回顾性分析北京协和医院1990年5月至2010年5月收治的韦格纳肉芽肿合并肺结核8例的临床特征, 并复习相关文献。 结果 8例患者中男性5例, 女性3例; 发病年龄最小19岁, 最大70岁, 平均年龄52.7岁。首先诊断韦格纳肉芽肿, 并在激素应用过程中诊断肺结核5例, 这5例患者均为痰涂片抗酸杆菌阳性患者, 其中4例否认结核病史及结核接触史; 同时诊断韦格纳肉芽肿合并肺结核2例; 首先诊断肺结核, 后诊断合并韦格纳肉芽肿1例。临床表现肺部最常见为咯血, 其次为咳嗽、咳痰, 其他器官受累包括肾脏(异型红细胞尿), 耳鼻喉(流脓涕、听力受损)。韦格纳肉芽肿合并结核感染的治疗, 在尽量不减少激素剂量的同时加强抗结核治疗。 结论 韦格纳肉芽肿合并肺结核并不少见, 应引起临床医生的重视, 早期诊断, 积极治疗, 改善预后。 Abstract:Objective To analyze the clinical manifestations of patients with Wegener's granulomatosis (WG) and pulmonary tuberculosis (TB). Methods We retrospectively analyzed the clinical data of 8 patients with Wegener's granulomatosis combined with pulmonary tuberculosis in Peking Union Medical College Hospital from May 1990 to May 2010. Results There were 5 men and 3 women aged 19-70 years. Five patients were initially diagnosed as Wegener's granulomatosis but were confirmed to be with pulmonary tuberculosis during corticosteroid therapy. All these five patients had positive acid-fast bacilli smear test results, and four of them denied past a history of tuberculosis or tuberculosis exposure. Two were diagnosed as Wegener's granulomatosis and pulmonary tuberculosis almost the same time. In the remaining one case, tuberculosis was diagnosed firstly, and then Wegener's granulomatosis was also identified. The most common clinical manifestation in lung was hemoptysis, followed by cough and expectoration. Other involved organs included kidney (abnormal red blood cells in urine) and ear/nose/throat (suppuration and hearing impairment). Management was mainly based on anti-TB therapy and enhanced corticosteroid therapy. Conclusions Patients with Wegener's granulomatosis combined with pulmonary tuberculosis are not uncommon. Early diagnosis and treatment can improve the prognosis. -
Key words:
- pulmonary tuberculosis /
- Wegner's granulomatosis
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[1] Cordier JF, Valeyre D, Guillevin L.Pulmonary Wegener's granulomatosis:a clinical and imaging study of 77 cases[J]. Chest, 1990, 97:906-912. doi: 10.1378/chest.97.4.906 [2] Duna GF, Galperin C, Hoffman GS.Wegener's granulomatosis[J]. Rheum Dis Clin North Am, 1995, 21:949-986. https://pubmed.ncbi.nlm.nih.gov/14968341/ [3] Hagen EC, Daha MR, Hermans J, et al.Diagnostic value of standandized assays for anti-neutrophil cytoplasmic antibodies in idiopathicsy stemic vasculitis.EC/BCR Project for ANCA Assay Standardization[J]. Kidney Int, 1998, 53:743-753. doi: 10.1046/j.1523-1755.1998.00807.x [4] Pradhan VD, Badakere SS, Ghosh K, et al.Spectrum of anti-neutrophil cytoplasmic antibodies in patients with pulmonary tuberculosis overlaps with that of Wegener's granulomatosis [J]. Indian J MedSci, 2004, 58:283-288. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=81391c72a549c8b1d5961370edf4b209 [5] Flores-Suárez LF, Cabiedes J, Villa AR, et al.Prevalence of antineutrophil cytoplasmic autoantibodies in patients with tuberculosis[J]. Rheumatology, 2003, 42:223-229. doi: 10.1093/rheumatology/keg066 [6] Esquivel-Valerio JA, Flores-Suárez LF, Rodríguez-Amado J, et al, Antineutrophil cytoplasm autoantibodies inpatients with tuberculosis are directed against bactericidal/permeability increasing protein and are detected after treatment initiation [J]. Clin Exp Rheumatol, 2010, 28(1 Suppl57):35-39. http://www.ncbi.nlm.nih.gov/pubmed/20412700/ [7] Stone JH, Merkel PA, Spiera R, et al.Rituximab versus cyclophosphamide for ANCA-associated vasculitis[J]. N Engl J Med, 2010, 363:221-232. doi: 10.1056/NEJMoa0909905 [8] Toyoshima M, Chida K, Suda T, et al.Wegener's granulomatosis responding to antituberculous drugs[J]. Chest, 2001, 119:643-645. doi: 10.1378/chest.119.2.643 -
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