作者投稿
专家审稿
编辑办公
邮件订阅
RSS
-
摘要: 本文报道一例因“纳差2个月，皮肤及巩膜黄染1个月”就诊于北京协和医院老年医学科的患者。患者血清总胆红素、直接胆红素、血糖显著升高，血清IgG4水平升高近3倍，腹部影像学检查示胰腺弥漫性病变，胆总管胰内段明显狭窄，肝总管、左右肝管及分支增厚伴异常强化。患者病程中血糖亦显著升高，营养评估提示合并营养不良。由于患者高龄且多病共存，经多学科讨论后，给予中等剂量甲泼尼龙并快速减量，联合小剂量吗替麦考酚酯治疗，最终患者胆红素水平显著下降，黄疸基本消退，体质量恢复至起病前，躯体功能改善。在该例患者的诊疗过程中，多学科团队共同参与，逐步厘清病因，成功救治该患者，体现了多学科协作在老年疑难病诊疗中的重要作用。Abstract: In this paper, we report an elderly patient who had been experiencing poor appetite for one month and yellowing of the skin and sclera for two months before visiting the Department of Geriatrics at Peking Union Medical College Hospital. The patient's blood tests revealed significantly elevated levels of serum total bilirubin, direct bilirubin, and blood sugar. The serum IgG4 level nearly tripled. Abdominal imaging examinations revealed diffuse pancreatic lesions, narrowing of the intrapancreatic segment of the common bile duct, and thickening and marked enhancement of the common hepatic duct, left and right hepatic ducts, and branches. Blood glucose was also significantly elevated during the course of the disease. Moreover, nutritional assessment found that the patient was malnourished. After multidisciplinary discussion, a medium dose of oral methylprednisolone was prescribed to the patient due to his advanced age and multiple chronic conditions. The dose was then quickly reduced while the patient simultaneously received low-dose mycophenolate mofetil (MMF) treatment. As a result, the patient's bilirubin level significantly decreased, jaundice subsided, and his body weight returned to normal with improved physical function. Throughout the diagnosis and treatment process, a multidisciplinary team actively participated in discussions and gradually identified the underlying cause. This exemplifies the crucial role of interdisciplinary collaboration in effectively diagnosing and treating complex illnesses in elderly patients.
-
Key words:
- IgG4-related disease /
- jaundice /
- autoimmune pancreatitis /
- sclerosing cholangitis /
- elderly patient
作者贡献：张宁、武娟负责病例整理、论文撰写及修订；孙晓红负责论文构思及修订；康琳、袁灵、杨华夏、罗玲、芦波、周翔、张文负责参与多学科讨论并提供诊疗思路。利益冲突：所有作者均声明不存在利益冲突注：本文发表已获得患者本人知情同意。 -
[1] Kamisawa TZ, Yoh P, Shiv S, et al. IgG4-related disease[J]. Lancet, 2015, 385: 1460-1471. doi: 10.1016/S0140-6736(14)60720-0 [2] 师千与, 刘燕鹰. 免疫球蛋白G4相关疾病的诊治进展[J]. 中华风湿病学杂志, 2021, 25: 564-569. doi: 10.3760/cma.j.cn141217-20201120-00438 [3] Hisanori U, Okazaki K, Kawa S, et al. The 2020 revised comprehensive diagnostic (RCD) criteria for IgG4-RD[J]. Mod Rheumatol, 2021, 31: 529-533. doi: 10.1080/14397595.2020.1859710 [4] 张盼盼, 赵继志, 王木, 等. IgG4相关性疾病346例临床特征分析[J]. 中华内科杂志, 2017, 56: 644-649. doi: 10.3760/cma.j.issn.0578-1426.2017.09.005 [5] Sun L, Zhou Q, Brigstock DR, et al. Focal autoimmune pancreatitis and chronic sclerosing sialadenitis mimicking pancreatic cancer and neck metastasis[J]. World J Gastroenterol, 2014, 20: 17674-17679. doi: 10.3748/wjg.v20.i46.17674 [6] Amaar G, Chari ST, Smyrk TC, et al. Value of serum IgG4 in the diagnosis of autoimmune pancreatitis and in distinguishing it from pancreatic cancer[J]. Am J Gastroenterol, 2007, 102: 1646-1653. doi: 10.1111/j.1572-0241.2007.01264.x [7] da Silva Fink J, Marcadenti A, Rabito EI, et al. The New European Society for Clinical Nutrition and Metabolism Definition of Malnutrition: Application for Nutrition Assessment and Prediction of Morbimortality in an Emergency Service[J]. J Parenter Enteral Nutr, 2018, 42 : 550-556. [8] Wallace ZS, Naden RP, Chari S, et al. The 2019 American College of Rheumatology/European League Against Rheumatism classification criteria for IgG4-related disease[J]. Ann Rheum Dis, 2020, 79: 77-87. [9] Chapman MH, Thorburn D, Hirschfield GM, et al. British Society of Gastroenterology and UK-PSC guidelines for the diagnosis and management of primary sclerosing cholangitis[J]. Gut, 2019, 68: 1356-1378. doi: 10.1136/gutjnl-2018-317993 [10] 刘晓红, 陈彪. 老年医学[M]. 北京: 人民卫生出版社, 2020: 229. [11] 黎磊石, 王海燕, 林善锬, 等. 吗替麦考酚酯治疗弥漫增生性狼疮性肾炎的多中心临床研究[J]. 中华内科杂志, 2002, 41: 476-479. doi: 10.3760/j.issn:0578-1426.2002.07.014 -
下载:
点击查看大图
图(3)
计量
- 文章访问数: 340
- HTML全文浏览量: 65
- PDF下载量: 69
- 被引次数: 0
