抗中性粒细胞胞浆抗体(ANCA)相关血管炎性中耳炎的诊治分析

Otitis Media with Antineutrophil Cytoplasmic Antibody (ANCA)-associated Vasculitis(OMAAV):Definition and Early Diagnosis

张志坚;任杰;曹永茂;廖华;杨希林;徐勇;汪雷;王文静;华清泉;

1:武汉大学人民医院耳鼻咽喉头颈外科中心

摘要
目的 探讨抗中性粒细胞胞浆抗体(ANCA)相关血管炎性中耳炎(otitis media with antineutrophil cytoplasmic antibody-associated vasculitis, OMAAV)的临床特点及诊治方法。方法 在中国知网、维普、万方等中文数据库中,检索以分泌性中耳炎为首发症状的ANCA相关血管炎临床病例,结合1例经治的OMAAV病例,总结其临床特点、诊治及预后。结果 检索到以分泌性中耳炎为首发症状的ANCA相关血管炎相关文献5篇病例7例,加上本研究的1例(简称“本例”)共8例患者,均以分泌性中耳炎为首发症状,其中3例继发耳痛,3例继发鼓膜紧张部穿孔,1例出现面瘫。除本例患者外,其余7例均在出现发热、肺部结节等耳部以外表现后方得以确诊,确诊时间1月~3年,平均10.3月,其中5例确诊依据是耳部以外组织活检加ANCA血清学检查,2例是临床表现加ANCA血清学检查;2例死于ANCA相关血管炎,其余5例经治疗后病情缓解。本例患者根据日本耳科学会最近提出的OMAAV诊断标准确诊并及时给予激素和硫唑嘌呤治疗,预后良好。结论 以分泌性中耳炎、周围性面瘫及耳痛等耳部症状为首发症状的ANCA相关血管炎早期临床症状不典型,极易误诊。建议根据OMAAV相关诊断标准早期进行规范诊治,减少误诊漏诊,改善预后。
关键词
抗中性粒细胞胞浆抗体;ANCA相关血管炎;ANCA相关血管炎性中耳炎;分泌性中耳炎;周围性面瘫
基金项目(Foundation):
国家自然科学基金面上项目(81271073);; 教育部留学回国基金(302-153775)
作者
张志坚;任杰;曹永茂;廖华;杨希林;徐勇;汪雷;王文静;华清泉;
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