User:Koala0090/沙盒一：修订间差异
无编辑摘要 |
无编辑摘要 |
||
| 第27行： | 第27行： | ||
|url=http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm251946.htm |
|url=http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm251946.htm |
||
|accessdate=20 April 2011 |date=19 April 2011 }}<br/>{{cite web |title=RITUXAN (rituximab) injection, solution |work=Daily Med |publisher=U.S. National Library of Medicine |url=http://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=b172773b-3905-4a1c-ad95-bab4b6126563}}</ref>--> |
|accessdate=20 April 2011 |date=19 April 2011 }}<br/>{{cite web |title=RITUXAN (rituximab) injection, solution |work=Daily Med |publisher=U.S. National Library of Medicine |url=http://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=b172773b-3905-4a1c-ad95-bab4b6126563}}</ref>--> |
||
臨床症狀、理學檢查、生化檢驗、病理切片是診斷GPA和MPA的重要根據。在臨床診斷方面，目前尚無有效診斷ANCA相關性血管炎（ANCA-associated vasculitis，AAV）的臨床標準，需透過臨床證據綜合判斷。必須懷疑血管炎的症狀包含[[腎絲球腎炎]]、呼吸道出血，或是多發性神經病變。MPA病人與GPA、EGPA相比，更容易會有腎臟進犯。因此若病人懷疑有腎炎，應考慮腎臟切片以協助診斷 |
|||
血清ANCA的種類和數值可以做為參考依據，MPA較常為MPO-ANCA（pANCA），GPA則較常為PR3-ANCA（cANCA）。血清ANCA陰性並不能排除AAV。 |
|||
| 第33行： | 第35行： | ||
在實驗室診斷方面，數據的異常通常依其進犯位置而定，通常病人會有血清ANCA上升的狀況， |
|||
| ⚫ | |||
若病人出現血尿、蛋白尿、肌酸酐上升等情形，需考慮腎臟切片 |
|||
<ref>https://www.nature.com/articles/s41572-020-0204-y#Sec26</ref> |
|||
==Diagnosis== |
|||
至於ANCA血管炎的分類標準，則有DCVAS標準及 |
|||
。 |
|||
有效的 |
|||
診斷標準 |
|||
| ⚫ | |||
2024年11月7日 (四) 09:32的版本
診斷
在血液檢查上，患者常會出現红细胞沉降率（ESR）上升、C反應蛋白（CRP）上升、貧血等現象。若患者的腎臟遭到進犯，病人的血清肌酸酐數值會上升，尿液檢查則可以看到蛋白尿及血尿等情形。
患者的神經病變，由"肌電圖"(EMG)可顯示出一種"感覺運動性周圍神經病"(sensorimotor peripheral neuropathy)。
An important diagnostic test is the presence of perinuclear antineutrophil cytoplasmic antibodies (p-ANCA) with myeloperoxidase specificity[1] (a constituent of neutrophil granules)
Depending on which organ is affected special tests can be performed, such as renal biopsy in patients with kidney failure or electromyography in patients with peripheral neuropathy [2]
Differential diagnosis
The signs and symptoms of microscopic polyangiitis may resemble those of granulomatosis with polyangiitis (GPA) (another form of small-vessel vasculitis) but typically lacks the significant upper respiratory tract involvement (e.g., sinusitis) frequently seen in people affected by GPA.[來源請求]
治療
常規治療涉及長效劑量的潑尼松，或與之交替性的使用或組合性使用的藥物，如與細胞毒性藥物、比如環磷酰胺或硫唑嘌呤交替使用或組合成複方藥物(Combination drug)使用。
血漿置換法(Plasmapheresis)，也可以使用在急性期以消除ANCA抗體(Anti-neutrophil cytoplasmic antibody)。 臨床症狀、理學檢查、生化檢驗、病理切片是診斷GPA和MPA的重要根據。在臨床診斷方面，目前尚無有效診斷ANCA相關性血管炎（ANCA-associated vasculitis，AAV）的臨床標準，需透過臨床證據綜合判斷。必須懷疑血管炎的症狀包含腎絲球腎炎、呼吸道出血，或是多發性神經病變。MPA病人與GPA、EGPA相比，更容易會有腎臟進犯。因此若病人懷疑有腎炎，應考慮腎臟切片以協助診斷
血清ANCA的種類和數值可以做為參考依據，MPA較常為MPO-ANCA（pANCA），GPA則較常為PR3-ANCA（cANCA）。血清ANCA陰性並不能排除AAV。
在實驗室診斷方面，數據的異常通常依其進犯位置而定，通常病人會有血清ANCA上升的狀況， 若病人出現血尿、蛋白尿、肌酸酐上升等情形，需考慮腎臟切片
至於ANCA血管炎的分類標準，則有DCVAS標準及 。 有效的 診斷標準
https://www.nature.com/articles/s41572-020-0204-y
Treatment
Immunsuppressive treatment is the gold standard management in order to achieve remission of the blood vessel inflammation that occurs in active microscopic polyangitis. The current immunosuppressive protocols consists of a combination of high dose of glucocorticoids in combination with either cyclophosphamide or Rituximab.[4] In cases of life threatening disease treatment with plasmapheresis can also be applied.
The immunosuppressive treatment is slowly tapered down under a period of several months but there is at the moment no consensus about the total duration of the therapy. Discontinuation of immunosuppression can be related to increased risk for disease flares.
- ^ Seishima M, Oyama Z, Oda M. Skin eruptions associated with microscopic polyangiitis. Eur J Dermatol. 2004, 14 (4): 255–8. PMID 15319159.
- ^ Houben, Eline; Bax, Willem A.; van Dam, Bastiaan; Slieker, Walentina A.T.; Verhave, Gideon; Frerichs, Fenneke C.P.; van Eijk, Izhar C.; Boersma, Wim G.; de Kuyper, Guido T.M.; Penne, Erik L. Diagnosing ANCA-associated vasculitis in ANCA positive patients: A retrospective analysis on the role of clinical symptoms and the ANCA titre. Medicine. October 2016, 95 (40): e5096. ISSN 0025-7974. PMC 5059091
. PMID 27749588. doi:10.1097/MD.0000000000005096 （英语）.
- ^ https://www.nature.com/articles/s41572-020-0204-y#Sec26
- ^ Geetha, Duvuru; Jefferson, J. Ashley. ANCA-Associated Vasculitis: Core Curriculum 2020. American Journal of Kidney Diseases. 2020-01-01, 75 (1): 124–137. ISSN 0272-6386. PMID 31358311. S2CID 198983998. doi:10.1053/j.ajkd.2019.04.031 （English）.