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題名 | Glomerular Fingerprint Deposits in a Young Woman with Stroke and Antiphospholipid Syndrome=發現腎絲球指紋狀沉澱物於抗磷脂症候群及腦中風之年輕女性病患 |
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作者 | 張玉梅; 吳志仁; 陳天令; 薛一鴻; 陳逸洲; 陳漢湘; 葉瑞圻; 曾嶔元; | 書刊名 | 內科學誌 |
卷期 | 13:1 2002.02[民91.02] |
頁次 | 頁31-37 |
分類號 | 415.121 |
關鍵詞 | 腎絲球指紋狀沉澱物; 抗磷脂症候群; 腦中風; Fingerprint deposits; Anti-ds-DNA; Antiphospholipid syndrome; |
語文 | 英文(English) |
中文摘要 | 要確立診斷不同型態之腎臟病,腎組織切片之超微結構評估佔有樞紐性地位。我們報告一位 20 歲女性病人,有抗磷脂症候群, 蛋白尿一天 1.4 克 ,抗細胞核自體抗體 (ANA)1:640, 發生了腦中風。但沒有抗雙螺旋鏈去氧核酸核酸(anti-ds-DNA) 。雖然沒有抗雙螺旋鏈去氧核醣核酸,我們仍然強烈懷疑紅斑性狼瘡合併腎病變。血管攝影顯示血管炎。因此給予脈衝甲基去氫氧化可體松 (methylprednisolone) 靜注後給予口服類固醇。腎臟切片時 ,在電子顯微鏡下發現指紋狀沉澱物,病理診斷為 classIII狼瘡性腎炎。紅斑性狼瘡及冷凝球蛋白血症之組織切片均可有指紋狀沉澱物 ,而我們的病人並沒有冷凝球蛋白。因此使用不同方法重測 anti-ds-DNA 時卻呈正反應。六個月後病人之神經症狀完全恢復。本病例說明了當高度懷疑紅斑性狼瘡時積極追查之重要性。 |
英文摘要 | Ultrastructural evaluation of a renal biopsy specimen plays a pivotal role in accurately characterizing the types of renal involvement. We report a case of a 20 year old woman, presenting with stroke with antiphospholipid syndrome, proteinuria (1.4 g per day), antinuclear autoantibody positive at 1:640 dilution, but negative anti-double-stranded deoxyribonucleic acid (anti-ds-DNA). Despite the negative anti-ds-DNA, we still strongly suspected systemic lupus erythematosus (SLE) with renal involvement. Angiography was suggestive of vasculitis, so methylprednisolone pulse therapy was started, followed by oral prednisolone. On renal biopsy, fingerprint deposits were diagnosed on electron microscopy, and the pathologic diagnosis was Class III lupus nephritis. Fingerprint deposits are found in SLE and mixed cryoglobulinemia. But our case had negative cryoglobulin. A repeat test for anti-ds-DNA using a different method was positive. The patient completely recovered neurologically about six months after presentation. This case illustrates the importance of actively pursuing the diagnosis of SLE when there is a high index of suspicion for this disease. (J Intern Med Taiwan 2002;13:31-37 ) |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。