JAMA诊断检查解读抗中性粒细胞胞
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JAMADiagnosticTestInterpretationSeptember6,ClinicalSignificanceofaPositiveAntineutrophilCytoplasmicAntibody(ANCA)TestVietL.Bui,TanazA.KermaniJAMA.;(9):-.doi:10./jama...
A67-year-oldwomanwithahistoryofidiopathicpulmonaryfibrosiswasadmittedtothehospitalfornewonsetofcoughwithblood-streakedsputum,whichfollowedseveralmonthsofweightloss,anorexia,nausea,vomiting,andabdominalpain.Shereportednooccurrenceoffever,rashes,oralulcers,Raynaudphenomenon,chestpain,dyspneaonexertion,paresthesia,orjointconcerns.Onexamination,hertemperaturewas36.9°C,bloodpressurewas/81mmHg,pulsewas/min,andoxygensaturationlevelwas91%breathingroomair.Sheappeareddyspneic,hadnoheartmurmur,andhaddiffusecracklesespeciallyatthelungbasesand2+pittingedemaofthelegswithoutjugularvenousdistension.Norashes,synovitis,orfocalneurologicaldeficitswerefound.Laboratoryevaluationshowedahemoglobinlevelof7.5g/dLfromabaselineof10.4g/dL(referencerange,11.6-15.2g/dL);acreatininelevelof6.5mg/dLfromabaselineof1.2mg/dL(referencerange,0.6-1.2;SIconversiontoμmol/L,multiplyby88.4);andnormalwhitebloodcellcount,platelets,andlactate.Urinalysisshowedthepresenceofredbloodcellsbutnoprotein.Chestx-rayshowednewbilateralopacities.Computedtomographicimagingofthechestshowedmoderatestablefibrosiswithmultipleground-glassopacitiesintheleftlung.Basedontheseresults,additionalstudieswereperformed(Table).
一名有特发性肺间质纤维化的67岁女性患者因新发咳嗽、咯血性痰，体重下降、厌食、恶心、呕吐及腹痛数月入院。患者主诉没有发热、皮疹、口腔溃疡、雷诺现象、胸痛、活动后呼吸困难、感觉异常或关节异常。体格检查发现，体温36.9°C，血压/81mmHg，脉搏/min，吸空气时氧饱和度91%。患者表现呼吸困难，没有心脏杂音，肺部听诊可闻及弥漫性爆裂音，以肺底更为明显，下肢可凹性水肿2+，无颈静脉充盈。无皮疹、滑膜炎或神经系统局灶体征。实验室检查发现，血红蛋白从基线的10.4g/dL下降到7.5g/dL（正常范围11.6-15.2g/dL），肌酐水平从基线的1.2mg/dL升高到6.5mg/dL（正常范围0.6-1.2；转换成国际单位，乘以88.4）；白细胞计数、血小板计数及乳酸正常。尿常规显示有红细胞，蛋白阴性。胸片显示新发双侧透光度降低。胸部CT扫描显示左肺中度纤维化伴多发磨玻璃样改变。根据上述结果，进行了以下检查（表）。
问题：如何解读上述检查结果答案：C.患者有显微镜下多血管炎(MPA)。TESTCHARACTERISTICSAntineutrophilcytoplasmicantibodies(ANCAs)aredirectedtowardthecytoplasmic北京正规治疗白癜风医院白癜疯
