老年系统性血管炎合并肠梗阻2例并文献复习

目的提高对老年系统性血管炎的认识。 方法回顾性分析2006年1月至2017年1月广州军区广州总医院收治的89例老年系统性血管炎患者的临床资料,重点分析其中合并肠梗阻的2例患者,分析其临床特点、诊疗过程以及预后。 结果老年系统性血管炎临床表现多样,发热为常见症状,常伴有乏力、咳嗽、头晕、胸痛、失眠等非特异性症状;全身各个脏器均可受累,以肾脏、肺脏受累最为常见;多数患者血沉、C反应蛋白可升高。合并肠梗阻的2例患者中,1例诊断为"过敏性血管炎",经激素联合吗替麦考酚酯治疗后病情好转;另1例因肠梗阻入院行手术治疗,误诊为"缺血性肠病",1年后患者出现进行性肾功能损害,血清胞浆型和核周型抗中性粒细胞胞浆抗体强阳性,修正诊断为"显微镜下血管炎"。因患者高龄未接受激素治疗,迅速出现急性肾功能衰竭,治疗无效死亡。 结论以肠梗阻为首发症状或并发症的老年患者需排除系统性血管炎,以免延误诊断治疗。

Diagnosis and treatment of 2 cases of systemic vasculitis with intestinal obstruction in the elderly

ObjectiveTo improve the understanding of systemic vasculitis in the elderly. MethodsRetrospectively analyzed the clinical data of 89 elderly patients with systemic vasculitis (SV) from January 2006 to January 2017 in our hospital. Among them we focused on the data of two patients with intestinal obstruction, including the clinical features, diagnosis, treatment process and prognosis. ResultsSV had various clinical manifestations. Among them, fever was a common symptom, and other nonspecific symptoms were often accompanied, such as fatigue, cough, dizziness, chest pain, and insomnia. All organ dysfunction can be involved, especially kidney and lung. In most patients, ESR or CRP were usually raise. Among them 2 patients complicated with intestinal obstruction, 1 was diagnosed as allergic vasculitis, who was treated with glucocorticoid and mycophenolate mofetil and was relieved. The other patient underwent surgery for intestinal obstruction and misdiagnosed as "ischemic intestinal disease". One year later, the patient developed progressive renal impairment, and the cytoplasmic and perinuclear anti-neutrophil cytoplasmic antibodies were strongly positive. The diagnosis was corrected to "microscopic vasculitis". Due to the patient's advanced age and without receiving hormone therapy, the patients suffered from acute renal failure and quickly died. ConclusionElderly patients with intestinal obstruction as the initial symptom or complication need to be excluded for systemic vasculitis, so as to avoid misdiagnosis.