每日一题_2023.04.04

A 53-year-old man with a long-standing his- tory of allergic rhinitis and asthma presents with uveitis, mild hearing loss, numbness and tingling in his right hand, and diffuse joint pain for the past 10 days. Physical examination shows weak to absent left knee patellar reflexes (right knee reflex strong and intact). Laboratory studies show a markedly elevated eosinophil count. A diagnosis is made, and the patient is treated with cyclophosphamide. Further laboratory studies show elevated serum levels of the most common autoantibody associated with this condition. What structure is primarily targeted by the autoantibodies that are most likely elevated in this patient’s serum?

一名长期患有过敏性鼻炎和哮喘的53岁男性在过去10天出现葡萄膜炎，轻度听力下降，右手麻木和刺痛，弥漫性关节痛。体格检查:左膝髌骨反射弱至缺如(右膝反射强而完整)。实验室检查显示嗜酸性粒细胞计数明显升高。确诊后，患者接受环磷酰胺治疗。进一步的实验室研究表明，与这种疾病相关的最常见自身抗体的血清水平升高。该患者血清中最有可能升高的自身抗体的主要靶点是什么结构?

(A) Acetylcholine receptors 乙酰胆碱受体

(B) Neutrophils中性粒细胞

(C) Oligodendrocytes少突胶质细胞

(D) RBCs

(E) Thyroid-stimulating hormone receptors促甲状腺激素受体

答案解析：

该患者患变应性肉芽肿性血管炎(也称为变应性肉芽肿和血管炎)，这是三种疾病(韦格纳肉芽肿和显微镜下多血管炎是另外两种)之一，通常被称为ANCA(抗中性粒细胞胞质抗体)相关输精管炎(即引起血管或淋巴管炎症的疾病)。50% ~ 70X%的Churg-Strauss综合征患者ANCA水平升高，通常是核周型染色型(P-ANCA)。肺血管受累常见，患者通常有哮喘和过敏性鼻炎。它们还表现为嗜酸性粒细胞计数显著升高和多发性单神经炎(身体不同区域的2条或数条周围神经同时缺失)。其他症状包括葡萄膜炎、传导性听力损失和肌肉/关节疼痛。嗜酸性粒细胞性胃肠炎可先于其他症状出现。

正确答案：B