显微镜下多血管炎并分泌性中耳炎误诊原因分析

Misdiagnosis Analysis of Microscopic Polyangiitis with Secretory Otitis Media

目的探讨显微镜下多血管炎(microscopic polyangiitis,MPA)的耳部表现及诊治措施,并分析误诊原因,以减少误诊误治。方法回顾性分析我院诊治的1例并分泌性中耳炎的MPA的临床资料。结果患者以双侧中耳积液、传导性听力下降为主要症状,首诊为分泌性中耳炎,给予药物保守治疗、双耳多次穿刺抽液及反复鼓膜切开置管等治疗,效果不佳。后患者出现咳嗽、咳痰及痰中带血等症状。行抗中性粒细胞胞浆抗体等相关检查,诊断为MPA,予泼尼松加环磷酰胺等药物治疗,患者病情缓解。现随访观察中。结论部分MPA患者可出现耳部症状,以中耳积液及中耳感染甚至感音神经性耳聋为主要表现。加强对该病认识、仔细病史询问和及时进行相关检查可减少MPA患者误诊误治,早诊断、早治疗可改善MPA患者预后。

Objective To investigate the manifestations on the ear,diagnostic and therapeutic modalities for microscopic polyangiitis（ MPA）,and to analyze the cause of misdiagnosis in order to reduce misdiagnosis and mistreatment rates.Methods The clinical data of one patient admitted into our hospital for MPA with secretory otitis media was retrospectively analyzed. Results The patient＇s major symptoms were bilateral middle ear effusion and conductive hearing loss. Firstly,the patient was diagnosed with secretory otitis media. After receiving conservative medicine treatment,repeated puncture drainage and myringotomy with catheter drainage,and undergoing myringotomy and tube insertion repeatedly with no effect,the patient showed the symptoms of cough,expectoration,and had blood in sputum. Subsequently,the anti-neutrophil cytoplasmic antibodies（ ANCA） relevant tests were made,and the diagnosis of MPA was established. After the administration of Prednisone and Cyclophosphamide,the patient＇s clinical condition improved. Now the patient is on a follow-up. Conclusion Some MPA patients may have ear symptoms,commonly seen as middle ear effusion,middle ear infections,and even sensorineural deafness. A thorough recognition of this disease,detailed medical history enquiry and timely specific examinations may reduce the misdiagnosis and mistreatment rates. Early diagnosis and therapy can improve the prognosis of MPA.