每日一题_2023.09.10

A 50-year-old woman complains of dark- colored urine and says she has not been feeling well for the past two-three weeks; she has generalized malaise and a nagging cough that occasionally is productive of blood-tinged sputum. However, she noticed changes in her urine for the first time today. Physical examination reveals an ill-appearing middle-aged woman with a blood pressure of 180/110 mm Hg. Diminished air entry in the lungs bilaterally, and an ulcerated lesion of the mucosa of the right naris, are noted. There is no history of asthma or allergies. Urinalysis is grossly positive for blood, and serum chemistry panel reveals a creatinine level of 1.7 mg/dL. What additional finding would confirm the most likely diagnosis?

一名50岁女性主诉尿液颜色深，并表示过去2 – 3周一直感觉不舒服；患者全身不适，持续咳嗽，偶尔咳出带血的痰。然而，她今天第一次注意到她的尿液发生了变化。体格检查显示一名外表不佳的中年女性，血压为180/110 mmhg。双肺吸入空气减少，右鼻孔黏膜溃疡性病变。无哮喘或过敏史。尿液分析显示血液明显阳性，血清化学检查显示肌酐水平为1.7 mg/dL。还有什么其他发现可以证实最有可能的诊断?

(A)  Eosinophilia on WBC differential白细胞分类中的嗜酸性粒细胞增多

(B)  IgA deposition in glomerular mesangium肾小球系膜区IgA沉积

(C)  Linear IgG deposition in the kidney肾内IgG线状沉积

(D)  Positive for cytoplasmic anti-neutrophilic cytoplasmic antibodies胞质抗中性粒细胞胞质抗体阳性

(E)  Positive for hepatitis B乙型肝炎呈阳性

答案解析：

该患者的一系列症状最符合韦格纳肉芽肿病，有三联征:局灶性坏死性血管炎、上呼吸道和(或)下呼吸道坏死性肉芽肿和坏死性肾小球肾炎。大多数患者的胞浆染色模式(c-ANCA)抗中性粒细胞胞浆抗体滴度为阳性。这种疾病是由系统性肉芽肿性炎症引起的，特别是小动脉和中型动脉，如供应肾和肺的动脉。如果不使用免疫调节药物治疗，局灶性肾小球肾炎可进展为新月体形式，随后发生肾衰竭。

正确答案：A