以“转氨酶升高”为首发表现的飞行员干燥综合征1例

目的 报告 1 例以“转氨酶升高”为首发表现的飞行员干燥综合征,并讨论体检鉴定及航医工作。方法 报告 1 例以“转氨酶升高”为首发表现的飞行员干燥综合征的诊治过程及后续体检鉴定工作,讨论体检鉴定及航医工作。结果 该飞行员因“常规年度大体检发现转氨酶升高”入院,白细胞总数偏低;肝功能受损,抗“O”偏高、类风湿因子偏高。自身抗体谱：ANA、抗SSA、抗SSB、抗RO-52(+);EBV壳抗原IgA、IgG(+)：巨细胞病Ig抗体(+)。结合唇腺活检结果,干燥综合征诊断明确,给予“暂时飞行不合格,地面观察1个月”结论。经过规范治疗后,抗“O”及类风湿因子降低,血液指标恢复正常,肝功能恢复正常。规范治疗和健康指导3个月后,血常规、肝肾功能均无异常。考虑其为青年男性,既往体健,飞行意愿强烈,无口干眼干、无腹痛黄疸等症状,予“飞行合格”结论。结论干燥综合征能够引起全身多器官免疫性损伤,早期诊断和治疗存在较多困难,常导致病情迁延难愈,累及各器官系统并造成功能损害,可能影响到飞行员飞行安全。全面的康复指导、细心的病情观察是预防并发症、决定患者预后的关键。规范治疗和健康指导后,若复查血常规、肝肾功能均无异常,无特异性症状,可予“飞行合格”结论。

Sjogren's syndrome with "elevated transaminase" as the first manifestation in a pilot

Objective To report a case of pilot with Sjogren''s syndrome with "elevated transaminase" as the first manifestation. Methods We reported the diagnosis, treatment and follow-up physical examination of a pilot with "elevated transaminase" as the first manifestation of Sjogren''s syndrome and discussed the aviation medical work of pilots with Sjogren''s syndrome. Results The pilot was admitted to hospital due to the "increase of transaminase ". The total number of leukocytes was decreased; liver dysfunction existed; the levels of antistreptolysin-O and rheumatoid factor were increased. Autoantibody spectrum showed ANA(+), anti SSA(+), anti SSB(+), anti Ro-52 (+), EBV shell antigen IgA(+), IgG (+), and cytomegalovirus Ig antibody (+). Combined with the results of lip gland biopsy, the diagnosis of Sjogren''s syndrome was conformed. The conclusion of "temporarily unqualified flight, ground observation for 1 month" was drawn. After standardized treatment, the levels of antistreptolysin-O and rheumatoid factor were decreased, and the blood indexes and liver function returned to normal. After 3 months of standardized treatment, the routine blood tests and liver and kidney function returned to normal. Considering that the pilot was a young male, had good health history and a strong desire to fly, the conclusion of "qualified flight" was drawn as he had no other symptom. Conclusion Sjogren''s syndrome may cause systemic multiple organ immune injury. There are many difficulties in early diagnosis and treatment of it, which often leads to the delay of treatment, causing functional damage to various organ systems and impaired flight safety. Comprehensive rehabilitation guidance and careful condition observation is the key to prevent complications and to determine the prognosis of patients. After standardized treatment and healthcare guidance, the conclusion of "qualified flight" can be drawn if there is no abnormality in blood routine tests, liver or kidney function tests or no specific symptom.