以咽喉疼痛为首发症状的白塞病临床诊治分析

Analysis of clinical diagnosis and treatment of Behcet's disease with sore throat as the first symptom

目的:总结以咽喉疼痛为首发症状的白塞病的临床及诊疗特点,以提高临床医师对该病的认识。方法:回顾性分析2015年1月—2022年1月首诊于北京协和医院耳鼻咽喉科的28例白塞病患者的临床资料。所有患者初诊时均行电子鼻咽喉镜检查,并予以局部对症治疗。21例患者行C反应蛋白及血沉检查,另有部分患者行免疫指标检查。明确白塞病诊断后,治疗以免疫抑制剂为主,可根据病变程度及其他器官累及情况辅以口服激素治疗。结果:所有患者均以咽喉疼痛为首发症状,可伴有吞咽困难或呼吸困难,内镜检查发现口咽部溃疡25例(89.3%),喉部溃疡15例(53.6%),下咽部溃疡14例(50.0%),伴有鼻咽或咽喉粘连8例(28.6%)。所有患者均同时存在口腔溃疡,伴发生殖器溃疡者21例(75.0%),皮肤损害18例(64.3%),眼部病变11例(39.3%)。病程中伴关节受累4例(14.3%),神经系统病变3例(10.7%),消化系统病变1例(3.6%)。结论:以咽喉疼痛为首发症状的白塞病临床表现多样,溃疡可累及咽喉部多个部位,少数患者可累及全身多系统。临床上需予以重视,应尽早诊断、及时治疗,防止或延缓病变累及重要器官或系统。

Objective:To summarize the clinical and diagnostic characteristics of Behcet's disease with sore throat as the first symptom,so as to improve clinicians' understanding of the disease.Methods:The clinical data of 28 patients with Behcet's disease who were first treated in Department of Otorhinolaryngology,Peking Union Medical College Hospital from January 2015 to January 2022 were analyzed retrospectively.All patients were examined by electronic laryngoscopy at the first visit and treated with local symptomatic therapy.Twenty-one patients were examined for C-reactive protein and blood sedimentation,and some patients were examined for immunological parameters.After the diagnosis of leukoaraiosis was confirmed,treatment was based on immunosuppression and could be supplemented with oral hormone therapy depending on the extent of the lesion and other organ involvement.Results:Sore throat was the first symptom of all patients,which could be accompanied by dysphagia or dyspnea.Endoscopy revealed oropharyngeal ulcer in 25 cases(89.3%),laryngeal ulcer in 15 cases(53.6%),hypopharyngeal ulcer in 14 cases(50.0%),and adhesion of nasopharynx or throat in 8 cases(28.6%).All patients had oral ulcer at the same time,including 21 cases(75.0%) with genital ulcer,18 cases(64.3%) with skin damage,and 11 cases(39.3%) with eye disease.In the course of disease,there were 4 cases(14.3%) with joints involvement,3 cases(10.7%) with nervous system disease,and 1 case(3.6%) with digestive system disease.The treatment is mainly immunosuppressive,and oral hormone therapy can be supplemented according to the extent of the disease and the involvement of other organs.Conclusion:The clinical manifestations of Beh9et's disease,with sore throat as the first symptom,are diverse.The ulcer may involve multiple parts of the throat,and a few patients may involve multiple systems of the whole body.Clinical attention should be paid to the early diagnosis and timely treatment to prevent or delay the involvement of the lesion in important organs or systems.