兰州大学机构库 >学院待认领
狼疮性肾炎合并狼疮性肺炎1例报告并文献复习
Alternative TitleLupus nephritis compound with lupus pneumonia:a case report and review of the literature
李海端
Thesis Advisor李建华
2014-05-22
Degree Grantor兰州大学
Place of Conferral兰州
Degree Name硕士
Keyword系统性红斑狼疮 狼疮性肾炎 继发性肾病综合征 狼疮性肺炎
Abstract目的:探讨狼疮性肾炎的临床特点及、诊治及狼疮性肺部损害的特点。 方法:回顾性分析一例狼疮性肾炎合并狼疮性肺炎,首诊诊断为血小板减少性紫癜患者的病例资料并进行相关复习。 设计:病例报告 病例:患者于入院前3年出现全身紫癜伴浮肿,曾予激素规律治疗,入院前1月再次出现全身皮肤紫癜、水肿并伴心悸、腹痛及乏力。 干预:入院后行自身抗体检查,诊断为系统性红斑狼疮,并制定甲强龙联合环磷酰胺冲击治疗方案;明确贫血及血小板减低原因并积极纠正;间断利尿消肿,于后期介入连续血液净化治疗;行肾活检穿刺术,辅以降压、调脂及营养支持综合治疗。 结果:患者肾脏病理回报为狼疮性肾炎(III(A/C)+V),给予抑制免疫及营养支持治疗,但患者于病程中反复出现间断发热,多次行胸部影像学检查提示合并狼疮性肺炎 细菌性感染不排,经给予相应治疗后,血氧饱和度仍进行性降低,进展为I型呼吸衰竭,家属经商议后自动出院。 结论:系统性红斑狼疮为一种自身免疫性疾病,临床可出现多系统损害,但当生育期年龄女性患者表现为血液系统损害及肾脏损害,首要应行自身抗体筛查,据肾脏病理类型制定免疫抑制剂方案。系统性红斑狼疮患者出现肺部损害时诊断有一定困难,应注意与细菌性肺部感染相鉴别。
Other AbstractOBJECTIVE:Discuss with the manifestation and treatment of secondary nephrosyndrome resulted from lupus nephritis and to explore characteristics 0f lupus pneumonitis. . METHOD:To retrospectively analyze a clinical record about a patient with secondary nephrotic syndrome results from lupus nephritis who also suffers from lupus pneumonitis and to review the literature. DESIGN:Case report. PATIENT:The patients who occured with edema and purpura 3 years ago, has visited many hospitals,and was diagnosed as thrombocytopenic purpura/Chronic nephritis syndrome, received regular hormone therapy, but 1 month ago still repeated edema and purpura. along with heart palpitations,stamochache and fatigue. INTERVENTION:After admitted to hospital, in order to rule out the autoimmune disease,detected the autoantibodies and found anti-Sm and anti-nRNP are positive,in view of the other clinical symptoms,diagnosed of systemic lupus erythematosus. According to the SLEDAI score received methylprednisolone combined cyclophosphamide therapy.As to damage of the blood system,we gave positive supplementary of platelets and hematopoietic raw material,along with stimulating hematopoiesis to rectify anemia and corrected disturbances of blood coagulation,meanwhile we also did bone marrow puncture.For edema,gave diuretic dehydration and continuous blood purification therapy, and then did renal biopsy,the patient also recieved nutrition treatment. RESULT: Renal biopsy pathology confirmed as lupus nephritis (III(A/C) + V),the patient also has renal failure,giving the immunosuppression and nutritional treatment,however the patient fevered repeatedly,the chest suggested compounding lupus pneumonia,while bacterial infection is still possible,after increased the oxygen concentration and strengthened the antibiotic treatment,the patient still had progressive lower blood oxygen saturation,and finally progress to type I respiratory failure,according to opinions of relevant departments,there is risk of adult respiratory distress syndrome,the patient is in a critical condition,after consulting by kinship,the patient finally left the hospital. CONCLUSION:Systemic lupus erythematosus (SLE) is an autoimmune disease,especially happens in women of reproductive years, can appear different systemic damage,such asskin,joints,blood system and lung,kidney,braincan be infected.But when women of reproductive years appear as damage of blood system and kidney,we should detect autoantibodies at first,t...
URL查看原文
Language中文
Document Type学位论文
Identifierhttps://ir.lzu.edu.cn/handle/262010/223086
Collection学院待认领
Affiliation临床医学院
Recommended Citation
GB/T 7714
李海端. 狼疮性肾炎合并狼疮性肺炎1例报告并文献复习[D]. 兰州. 兰州大学,2014.
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