以腹泻为首发症状的淀粉样变3例及文献复习

doi:10.6040/j.issn.1671-7554.0.2019.1443

摘要/Abstract

摘要： 目的总结消化道淀粉样变的临床表现、原发疾病和诊断思路。方法报道就诊于山东大学齐鲁医院青岛院区消化内科确诊为消化道淀粉样变的3例病例,复习相关文献。结果 3例消化道淀粉样变临床表现缺乏特异性,主要临床表现为消化道出血、腹痛、腹泻、纳差、腹胀。肠镜检查主要表现为黏膜充血糜烂及不规则溃疡。结论消化道淀粉样变为少见病,临床表现复杂,缺乏特异性,误诊率高,需引起临床医生重视;淀粉样变所致的慢性腹泻早期表现多不典型,随着疾病进展出现多系统功能损害,进展迅速,预后差,故在临床工作中需将淀粉样变列为慢性腹泻鉴别诊断之一,及时识别多系统损害,重视病理活检,及时发现淀粉样变及其病因,提高患者的生存率。

关键词: 淀粉样变, 消化道, 腹泻, 系统性红斑狼疮, 多发性骨髓瘤

Abstract: Objective To summarize the clinical manifestations, primary diseases and diagnosis of digestive tract amyloidosis. Methods The clinical data of 3 cases of digestive tract amyloidosis treated in department of gastroenterology,Qilu Hospital of Shandong University(Qingdao)were analyzed and relevant literature was reviewed. Results This disease had no specific clinical manifestations, which included gastrointestinal bleeding, abdominal pain, diarrhea, poor appetite and abdominal distension. Colonoscopy indicated mucosal hyperemia and irregular ulcers. Conclusion Digestive tract amyloidosis is a rare disease with complex nonspecific clinical manifestations and high misdiagnosis rate. Chronic diarrhea secondary to amyloidosis is often atypical at the initial stage. Multisystem functional impairment occurs as the disease progresses rapidly and results in poor prognosis. Therefore, amyloidosis should be differentiated from chronic diarrhea in clinical practice. Timely identification of multisystem damage and pathological biopsy are useful in the diagnosis of amyloidosis and can improve patients survival rate.

Key words: Amyloidosis, Digestive tract, Diarrhea, Systemic lupus erythematosus, Multiple myeloma

中图分类号:

R442.2

王百惠,宋艳君,张帅庆,左秀丽,王青,张爱军,李如源. 以腹泻为首发症状的淀粉样变3例及文献复习[J]. 山东大学学报 (医学版), 2020, 58(5): 93-97.

WANG Baihui, SONG Yanjun, ZHANG Shuaiqing, ZUO Xiuli, WANG Qing, ZHANG Aijun, LI Ruyuan. Three cases of amyloidosis with diarrhea as the first symptom and literature review[J]. Journal of Shandong University (Health Sciences), 2020, 58(5): 93-97.

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