本文選題：復發(fā)性多軟骨炎　切入點：呼吸道受累　出處：《廣西醫(yī)科大學》2015年碩士論文

【摘要】：目的：探討復發(fā)性多軟骨炎累及呼吸道的臨床特征,以提高認識,早期發(fā)現(xiàn)并診斷,及早綜合性治療,改善預后。方法：對在廣西醫(yī)科大學一附院住院確診的1例復發(fā)性多軟骨炎累及呼吸道患者的臨床資料進行總結(jié)分析并結(jié)合文獻復習。結(jié)果：1.本例患者21歲男性,以反復發(fā)熱、胸痛、氣促為主要首發(fā)臨床癥狀,病程中出現(xiàn)聲音嘶啞、聽力下降、鞍鼻、雙眼視物模糊、皮疹,白細胞、C反應蛋白、血沉等指標升高,肺部CT示氣管、支氣管鈣化,肺功能提示阻塞性通氣功能障礙,纖維支氣管鏡見氣管上段狹窄,給予激素聯(lián)合免疫抑制劑治療后癥狀改善。2.文獻復習結(jié)果：從PUBMED等多個數(shù)據(jù)庫檢索從2005年1月年至2015年1月國內(nèi)外對RP患者累及呼吸道個案報道的例數(shù),初步檢索文獻74篇,依據(jù)診斷標準39篇符合,共報道50例,均有較完整的病史及臨床資料。其中男性29例,女性21例,年齡最小20歲,最大83歲,平均50.7歲。呼吸系統(tǒng)主要臨床表現(xiàn)為咳嗽、咳痰、呼吸困難、聲嘶及肺部哮鳴音。48例行肺CT檢查,多表現(xiàn)為氣管支氣管管壁增厚,管腔狹窄。28例行肺功能檢查,以阻塞性通氣功能障礙為主。只有10例行支氣管黏膜活檢。曾誤診為哮喘17例,支氣管炎12例,COPD5例。單純予激素治療好轉(zhuǎn)共14例,需加用免疫抑制劑22例,而需介入或無創(chuàng)機械通氣共10例。只有部分患者進行隨訪,1年后隨訪2例,2年后隨訪2例,5年后隨訪1例,均無復發(fā)。但1例患者半年后死于呼吸衰竭。結(jié)論：1.RP累及呼吸道患者主要癥狀為咳嗽、呼吸困難等,伴耳、鼻受累等肺外表現(xiàn)；2.肺功能以阻塞性通氣功能障礙為主要表現(xiàn),胸部影像學、支氣管鏡檢查可明確氣道受累情況；3.常易誤診為哮喘、支氣管炎等；4.全身治療以激素為主,局部治療包括手術介入、機械通氣,預后不佳。
[Abstract]:Objective: to investigate the clinical features of recurrent polychondrositis involving respiratory tract in order to improve the understanding, early detection and diagnosis, and early comprehensive treatment. Methods: to summarize and analyze the clinical data of a case of recurrent polychondrositis involving respiratory tract diagnosed in the first affiliated Hospital of Guangxi Medical University and review the literature. Results: 1. This case was 21 years old male with repeated fever. Chest pain and shortness of breath were the main clinical symptoms. In the course of the disease, hoarseness, hearing loss, saddle nose, blur of binocular vision, rash, leukocyte C reactive protein, erythrocyte sedimentation rate and so on were increased. Lung CT showed calcification of trachea and bronchus. Pulmonary function suggests obstructive ventilation dysfunction, fibrobronchoscopy shows upper trachea stenosis, Results of literature review: from January 2005 to January 2015, the number of cases reported on respiratory tract involvement in RP patients from January 2005 to January 2015 was retrieved from literature review, and 74 articles were preliminarily searched. According to 39 diagnostic criteria, 50 cases were reported with complete history and clinical data. Among them, 29 cases were male, 21 cases were female, the youngest was 20 years old, the maximum was 83 years old, the average was 50.7 years old. The main clinical manifestations of respiratory system were cough and expectoration. Pulmonary CT examination was performed in 48 cases with dyspnea, hoarseness and wheezing of lung. The main manifestations were thickening of tracheobronchial wall and stenosis of lumen in 28 cases. Only 10 cases of bronchial mucosal biopsy were misdiagnosed as asthma (17 cases), bronchitis (12 cases) and cod (5 cases). Only some patients were followed up, 2 cases after 1 year, 2 cases after 2 years, 1 case after 5 years. No recurrence occurred, but one patient died of respiratory failure half a year later. Conclusion 1. The main symptoms of respiratory tract involvement with RP are cough, dyspnea and other extrapulmonary manifestations. 2. Obstructive ventilation dysfunction is the main manifestation of pulmonary function. Chest imaging and bronchoscopy can identify airway involvement 3.It is often misdiagnosed as asthma, bronchitis and so on. 4. Hormone is the main treatment for the whole body. Local treatment includes surgical intervention, mechanical ventilation and poor prognosis.
【學位授予單位】：廣西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R593.2

【參考文獻】

相關期刊論文 前2條

1 李兆基 ,張速勤 ,馬超武 ,呂春雷 ,朱明 ,李蕾;雷公藤及類固醇治療復發(fā)性多軟骨炎[J];解放軍醫(yī)學雜志;2002年08期

2 李五一,何林,張連山,曹克利,張寶泉,倪道鳳,鐘紅;侵犯喉氣管支氣管的復發(fā)性多軟骨炎[J];中華耳鼻咽喉科雜志;1999年05期

，

本文編號：1656436