变应性肉芽肿性血管炎二例报告并文献复习_Chinese Journal of Respiratory and Critical Care Medicine

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变应性肉芽肿性血管炎; 临床分析

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10.7507/1671-6205.2014048

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目的加深对变应性肉芽肿性血管炎(又称Churg-Strauss综合征,CSS)的认识,提高临床诊断及治疗水平,改善预后。方法复习国内发表的临床诊断为CSS的28例病例,结合近期南华大学第二附属医院收治的2例变应性肉芽肿性血管炎病例进行临床分析。结果 30例患者中,男16例(53.3%),女14例(46.7%);年龄7~76岁,平均41.4岁。14例以喘息为首发症状,19例有支气管哮喘症状,病变可累及呼吸系统(63.3%)、神经系统(36.7%)、皮肤(50.0%)、消化系统(33.3%)、心脏(13.3%)、肾脏(6.7%)、关节肌肉(3.0%)、外周血管(6.7%)及眼部(6.7%)等。28例(93.3%)存在嗜酸粒细胞异常,平均值为29.5%,6例患者抗中性粒细胞胞浆抗体核周型(P-ANCA)、抗中性粒细胞胞浆抗体胞浆型(C-ANCA)检查均提示阳性。18例CSS患者肺部CT存在异常,多表现为浸润性、磨玻璃样、弥漫性间质样或结节样改变;14例取得病理学检查依据,表现为嗜酸粒细胞浸润,血管炎及血管外肉芽肿。临床治疗主要使用糖皮质激素和免疫抑制剂(如环磷酰胺),总体预后较好。结论变应性肉芽肿性血管炎是一种罕见的系统性血管炎疾病,临床表现缺乏特异性,易漏诊、误诊,当患者表现为哮喘、外周血嗜酸粒细胞增多及肉芽肿性血管炎时,应高度警惕此病。

Citation： 涂容芳, 张秀峰, 陈哲, 刘青, 曾赛丽, 谭小武, 何振华. 变应性肉芽肿性血管炎二例报告并文献复习. Chinese Journal of Respiratory and Critical Care Medicine, 2013, 12(2): 203-207. doi: 10.7507/1671-6205.2014048 Copy

1.	Gross WL. Churg-Stauss syndrome:updale on recent developments.Curr Opin Rheumatol,2002,14:11-14.
2.	梁慧,赵德育.儿童变应性肉芽肿性血管炎2例报告并文献复习.临床儿科杂志,2009,27:1165-1168.
3.	陈惠萍,曾彩虹.变应性肉芽肿性血管炎.肾脏病与透析肾移植杂志,1999,8:488-490.
4.	李琳,刘健,聂俊,等.变应性肉芽肿性血管炎心脏受累1例.临床心血管病杂志,2005,21:475.
5.	毛山,谷伟,谭焰,等.临床表现为哮喘样发作的肺部少见疾病四例误诊探讨.临床误诊误治,2012,25:32-34.
6.	贾益君,麦玉梅.变应性肉芽肿性血管炎并发皮肤难治性溃疡1例报告.第二军医大学学报,2011,32:928.
7.	符诒慧,董文,黄奕江,等.变应性肉芽肿性血管炎一例并文献复习.海南医学,2010,21:61-62.
8.	于光,张欢,边琪,等.病理表现为IgA肾病的变应性肉芽肿性血管炎1例报告及文献复习.第二军医大学学报,2010,31:1228-1231.
9.	张楠,王洪武,何晓蕴,等.长期以支气管哮喘误诊变应性肉芽肿性血管炎一例.中国血液流变学杂志,2009,19:568-568,576.
10.	薛青,焦维克,周素娟,等.长期误诊的变应性肉芽肿性血管炎一例.临床内科杂志,2005,22:138.
11.	房太勇,林玲,雷俊宝,等.上消化道症状为主的变应性肉芽肿性血管炎2例.中国中西医结合消化杂志,2004,12:252-253.
12.	戴冽,郑东辉,韩智娟,等.变应性肉芽肿性血管炎并发巴德-基亚里综合征1例报告.新医学,2003,34:184.
13.	朱燕林,王迁,张上珠,等.第29例:临床表现为胸闷、进行性喘憋加重.中国心血管杂志,2013,18:214-215.
14.	李永贤,崔红利.变应性肉芽肿性血管炎1例.工企医刊,2012,25:53-54.
15.	张永香.变应性肉芽肿性血管炎1例报告.首都医药,2010,17:58.
16.	肖明,甘梅富,卢薇,等.典型变应性肉芽肿性血管炎1例并文献复习.湖北民族学院学报(医学版),2009,26:62-63.
17.	王艳香.Churg-Strauss综合征及其肌电图改变2例.中国煤炭工业医学杂志,2007,10:824.
18.	康智敏,赵伟秦,李继梅,等.变应性肉芽肿性血管炎的临床及病理学特点(附4例报告).北京医学,2010,32:660-662.
19.	Wans RA,Lane SE,Bentham G,et al.Epidemiology of systemic vasculiti8:a ten-year study in the United Kingdom.Arthritis Rheum,2000,43:414-419.
20.	Natsugoe S,Matsumoto M,Okumura H,et al.Initial metastatic,including micrometastatic,sites oflymph nodes in esophageal squamous cell carcinoma.J Surg Oncol,2005,89:6-11.
21.	Nagashima T,Cao B,Takeuchi N,et al.Ciinicopathoiogicai studies of peripherai neuropathy in Churg-strauss syndrome.Neuropathology,2002,22:299-307.
22.	Baldini C,Talarico R,Della Rossa A,et al. Clinical manifestations and treatment of Churg-Strauss Syndrome.Rheum Dis Clin North Am,2010,36:527-543.
23.	Rashtak S,Pittelkow MR. Skin involvement in systemic autoimmune diseases.Curt Dir Autoimmun,2008,10:344-358.
24.	Dennen RM,van Paassen P,Schalla S,et al.Cardiacinvolvement in Churg-Strauss syndrome.Arthritis Rheum,2010,62:627-634.
25.	Della Rossa A,Baldini C,Tavoni A,et al.Churg-strauss syndmme:climcal and serological features of 19 patients from a singIe ItaIiaII centre.Rheumatology,2002,41:1286-1294.
26.	Takanashi T,Uchida S,Arita M,et al.Orbital inflammatory pseu-dotumor and ischemic vasculitis in Churg-Strauss syndrome:report of two cases and review of the literature.Ophthalmology,2001,108:1129-1133.
27.	Ovadia S,Dror I,Zubkov T,et al.Churg-Strauss syndrome:a rare presentation with otological and pericardial manifestations:case report and review of the literature.Clin Rheumatol.2009,28:35-38.
28.	Anna-Luise AK.Diagnosetic features and differential dignosis of Churg-Strauss syndrome in the lung.Am J Clin Pathol,2000,14:767-772.
29.	Guillevin L Advances in the treatments of systemic vasculitides.Clin Rev Allergy Immunol,2008,35:72-78.

1. Gross WL. Churg-Stauss syndrome:updale on recent developments.Curr Opin Rheumatol,2002,14:11-14.
2. 梁慧,赵德育.儿童变应性肉芽肿性血管炎2例报告并文献复习.临床儿科杂志,2009,27:1165-1168.
3. 陈惠萍,曾彩虹.变应性肉芽肿性血管炎.肾脏病与透析肾移植杂志,1999,8:488-490.
4. 李琳,刘健,聂俊,等.变应性肉芽肿性血管炎心脏受累1例.临床心血管病杂志,2005,21:475.
5. 毛山,谷伟,谭焰,等.临床表现为哮喘样发作的肺部少见疾病四例误诊探讨.临床误诊误治,2012,25:32-34.
6. 贾益君,麦玉梅.变应性肉芽肿性血管炎并发皮肤难治性溃疡1例报告.第二军医大学学报,2011,32:928.
7. 符诒慧,董文,黄奕江,等.变应性肉芽肿性血管炎一例并文献复习.海南医学,2010,21:61-62.
8. 于光,张欢,边琪,等.病理表现为IgA肾病的变应性肉芽肿性血管炎1例报告及文献复习.第二军医大学学报,2010,31:1228-1231.
9. 张楠,王洪武,何晓蕴,等.长期以支气管哮喘误诊变应性肉芽肿性血管炎一例.中国血液流变学杂志,2009,19:568-568,576.
10. 薛青,焦维克,周素娟,等.长期误诊的变应性肉芽肿性血管炎一例.临床内科杂志,2005,22:138.
11. 房太勇,林玲,雷俊宝,等.上消化道症状为主的变应性肉芽肿性血管炎2例.中国中西医结合消化杂志,2004,12:252-253.
12. 戴冽,郑东辉,韩智娟,等.变应性肉芽肿性血管炎并发巴德-基亚里综合征1例报告.新医学,2003,34:184.
13. 朱燕林,王迁,张上珠,等.第29例:临床表现为胸闷、进行性喘憋加重.中国心血管杂志,2013,18:214-215.
14. 李永贤,崔红利.变应性肉芽肿性血管炎1例.工企医刊,2012,25:53-54.
15. 张永香.变应性肉芽肿性血管炎1例报告.首都医药,2010,17:58.
16. 肖明,甘梅富,卢薇,等.典型变应性肉芽肿性血管炎1例并文献复习.湖北民族学院学报(医学版),2009,26:62-63.
17. 王艳香.Churg-Strauss综合征及其肌电图改变2例.中国煤炭工业医学杂志,2007,10:824.
18. 康智敏,赵伟秦,李继梅,等.变应性肉芽肿性血管炎的临床及病理学特点(附4例报告).北京医学,2010,32:660-662.
19. Wans RA,Lane SE,Bentham G,et al.Epidemiology of systemic vasculiti8:a ten-year study in the United Kingdom.Arthritis Rheum,2000,43:414-419.
20. Natsugoe S,Matsumoto M,Okumura H,et al.Initial metastatic,including micrometastatic,sites oflymph nodes in esophageal squamous cell carcinoma.J Surg Oncol,2005,89:6-11.
21. Nagashima T,Cao B,Takeuchi N,et al.Ciinicopathoiogicai studies of peripherai neuropathy in Churg-strauss syndrome.Neuropathology,2002,22:299-307.
22. Baldini C,Talarico R,Della Rossa A,et al. Clinical manifestations and treatment of Churg-Strauss Syndrome.Rheum Dis Clin North Am,2010,36:527-543.
23. Rashtak S,Pittelkow MR. Skin involvement in systemic autoimmune diseases.Curt Dir Autoimmun,2008,10:344-358.
24. Dennen RM,van Paassen P,Schalla S,et al.Cardiacinvolvement in Churg-Strauss syndrome.Arthritis Rheum,2010,62:627-634.
25. Della Rossa A,Baldini C,Tavoni A,et al.Churg-strauss syndmme:climcal and serological features of 19 patients from a singIe ItaIiaII centre.Rheumatology,2002,41:1286-1294.
26. Takanashi T,Uchida S,Arita M,et al.Orbital inflammatory pseu-dotumor and ischemic vasculitis in Churg-Strauss syndrome:report of two cases and review of the literature.Ophthalmology,2001,108:1129-1133.
27. Ovadia S,Dror I,Zubkov T,et al.Churg-Strauss syndrome:a rare presentation with otological and pericardial manifestations:case report and review of the literature.Clin Rheumatol.2009,28:35-38.
28. Anna-Luise AK.Diagnosetic features and differential dignosis of Churg-Strauss syndrome in the lung.Am J Clin Pathol,2000,14:767-772.
29. Guillevin L Advances in the treatments of systemic vasculitides.Clin Rev Allergy Immunol,2008,35:72-78.

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