咳嗽及肺部游走性阴影为主要表现的抗中性粒细胞胞浆抗体相关性血管炎1例

A case of antineutrophil cytoplasmic antibody associated vasculitis manifested with chronic cough and pulmonary migratory shadows

摘要:

笔者成功诊治1例65岁男性抗中性粒细胞胞浆抗体（ANCA）相关性血管炎患者。该患者主要表现为慢性咳嗽和肺部游走性阴影，曾被诊断为淋巴细胞性间质性肺炎，激素治疗有效，病情复发后查MPO-ANCA阳性，结合肺穿刺活检明确诊断为ANCA相关性血管炎，加用糖皮质激素和环磷酰胺后病情再次缓解。根据文献报道和笔者的临床经验，ANCA相关性血管炎临床表现复杂，缺乏特异性，常被误诊。呼吸科医师对ANCA相关性血管炎肺部受累特点应熟悉，要重视血清ANCA的筛查，以便于本病的早期诊断。

Abstract:

We reported a successful diagnosis and treatment of a 65-year-old male patient with pulmonary lesion caused by antineutrophil cytoplasmic antibody (ANCA) associated vasculitis. The main manifestations of the patient were chronic cough and pulmonary migratory shadows. He was once diagnosed as lymphocytic interstitial pneumonia, and received effective corticosteroid mono-treatment. MPO-ANCA was positive after the disease relapsed, and ultimately, the diagnosis of ANCA associated vasculitis was made after lung puncture biopsy. After combination administration of corticosteroid and cyclophosphamide, all signs and symptoms were relieved. According to literature and our clinical experience, ANCA associated vasculitis had complex, non-specific clinical manifestations, and thus, was often misdiagnosed. In order to facilitate the early diagnosis of this disease, respiratory physicians should be familiar with the characteristics of the pulmonary involvement of ANCA associated vasculitis, and pay more attention to serum ANCA screening.