一例ANCA相关性小血管炎所致肺损伤患者的循证诊断与治疗

Evidence-based diagnosis and treatment for a patient with lung damage caused by ANCA associated vasculitis.

目的借助循证医学的方法对一例ANCA阳性并有肺部侵犯的患者确定诊断,并制定最佳治疗方案。方法在充分评估患者病情的基础上,提出临床问题,从Cochrane图书馆、EMBS(1990.1～2008.8)以及http://www.guideline.gov/search/detailedsearch.aspx上进行检索。检索主题词为:ANCA;Antibodies Antineutrophil Cytoplasmic;ANC Aassociated vasculitis;treatment;diagonose;RCT;human;meta-analysis;systmatic review。结果共检出与不同问题相关的随机对照试验37篇,系统评价或Meta-分析3篇。通过对检索结果进行分析,为患者确定了ANCA相关性小血管炎的诊断,结合患者病情和意愿,为患者制定了最佳的治疗方案:静脉糖皮质激素(甲基强的松龙针40mg/次,2次/d),同时给予吸氧等对症治疗。患者体温恢复正常,胸闷、气促症状缓解,肾功能改善。结论采用循证的诊断及治疗方法,为这例ANCA阳性并有肺部侵犯的患者确定了诊断及合理的治疗方案,可以有效提高治疗效果。

Objective To make a diagnosis and an individualized treatment plan for a patient with lung damage caused by ANCA associated systemic vasculitis, according to evidence-based medicine. Methods After clinical problems were put forward, evidence was collect from Cochrane Liberty, EMBS （1990.1～2008.8） and http： // www. guideline. gov/search/detailedsearch.aspx according to the search strategy. Subject words were： ANCA; Antibodies Antineutrophil Cytoplasmic; ANCA associated vasculitis; treatment; diagonose; RCT; human; meta-analysis; systmatic review. Results A total of 37 RCTs, and 3 systematic reviews were identified. The diagnosis of ANCA associated vasculitis was determined. The best treatment plan was formulated, according to the symptoms and the will of the patients： venous corticosteroids （methyl-prednisone 40 mg/time, 2 times/day）, combined with oxygen therapy at the same time as symptomatic treatment. Body temperature of patients returned to normal, symptoms such as chest tightness and shortness of breath were relieved, and the renal function was improved. Conclusion The treatment plan formulated based on evidence-based methods significantly improves the clinical efficacy.