每日一题_2023.04.22

A 27-year-old man presents to the emergency department with a cough productive of blood- tinged sputum. He also complains that in the past couple weeks he has noticed increased fatigue and some blood in his urine. A renal biopsy is performed that, upon on immunofluorescence staining, shows a linear pattern of IgG deposition along the basement membrane. Which of the following is most likely responsible for this patient’s disease?

一名27岁男子因咳嗽带血痰来到急诊科。他还抱怨说，在过去的几周里，他感到越来越疲劳，尿液中有血。肾活检，免疫荧光染色，显示一个线性模式的IgG沉积沿基底膜。下列哪项最有可能导致这个病人的疾病?

(A) Anti-type III collagen antibodies 抗III型胶原抗体

(B) Anti-type IV collagen antibodies 抗IV型胶原抗体

(C) Antineutrophil cytoplasmic antibodies 抗中性粒细胞细胞质抗体

(D) Immune complexes免疫复合物

(E) T lymphocytesT淋巴细胞

答案解析：

以咯血为表现的年轻男性应提高对Goodpasture综合征的高度怀疑。他的疲劳和血尿支持了这一诊断(尽管典型的肾脏症状-肺部症状后几周到几个月)。随着病情的发展，可能会出现血尿、高血压和少尿的肾病症状。肾活检证实了Goodpasture综合征的诊断，免疫荧光染色显示IgG沿基底膜呈线性沉积。这些抗肾小球基底膜(GBM)抗体是针对IV型胶原a3链的特异性抗体，可对肾小球基底膜和肺泡基底膜造成损伤。

正确答案：B