{"id":5992,"date":"2019-11-29T11:24:46","date_gmt":"2019-11-29T03:24:46","guid":{"rendered":"https:\/\/wp-cc.meddatas.com\/?p=5992"},"modified":"2020-12-23T13:41:37","modified_gmt":"2020-12-23T05:41:37","slug":"66%e5%b2%81%e7%94%b7%e6%80%a7%e5%85%a8%e8%a1%80%e7%bb%86%e8%83%9e%e5%87%8f%e5%b0%91%e4%bc%b4%e7%9a%ae%e7%96%b9","status":"publish","type":"post","link":"https:\/\/wp-cc.meddatas.com\/?p=5992","title":{"rendered":"66\u5c81\u7537\u6027\u5168\u8840\u7ec6\u80de\u51cf\u5c11\u4f34\u76ae\u75b9"},"content":{"rendered":"

A 66-Year-Old Man with Pancytopenia and Rash.pdf<\/a><\/p><\/blockquote>\n

\u3010Case Report\u3011<\/p>\n

\u4e00\u540d\u60a3\u5168\u8840\u7ec6\u80de\u51cf\u5c11\u548c\u76ae\u75b9\u768466\u5c81\u7537\u6027<\/p>\n

Case 35-2019: A 66-Year-Old Man with Pancytopenia and Rash<\/p>\n

N Engl J Med 2019;381:1951-60.DOI: 10.1056\/NEJMcpc1909627<\/p>\n

\u62a5\u544a\u4eba\uff1a\u6768\u807f\u822a<\/p>\n

\u8bc4\u8bba\uff08\u4ec5\u4ee3\u8868\u4e2a\u4eba\u89c2\u70b9\uff09\uff1a<\/p>\n

\u672c\u75c5\u4f8b\u62a5\u544a\u4e86\u4e00\u540d66\u5c81\u7537\u6027\uff0c\u65e2\u5f80\u6709\u5168\u8840\u7ec6\u80de\u51cf\u5c11\u75c5\u53f2\uff0c\u8fd11\u5e74\u6765\u65e0\u660e\u663e\u8bf1\u56e0\u51fa\u73b0\u53d1\u70ed\u3001\u624b\u81c2\u548c\u817f\u90e8\u6563\u5728\u7cdc\u70c2\u6027\u76ae\u635f\u3001\u76f4\u7acb\u6027\u4f4e\u8840\u538b\u3001\u5934\u6655\uff0c\u4f34\u94c1\u86cb\u767d\u660e\u663e\u5347\u9ad8\uff0c\u767d\u7ec6\u80de\u3001\u8840\u7ea2\u86cb\u767d\u53ca\u8840\u5c0f\u677f\u51cf\u5c11\uff0c\u9aa8\u9ad3\u6d3b\u68c0\u548c\u7a7f\u523a\u7ed3\u679c\u663e\u793a\u7ec4\u7ec7\u7ec6\u80de\u8d28\u5185\u6709\u5927\u91cf\u541e\u566c\u7684\u7ea2\u7cfb\u6210\u5206\uff0c\u76ae\u635f\u6d3b\u68c0\u53d1\u73b0\u771f\u76ae\u548c\u76ae\u4e0b\u7ec4\u7ec7\u6709\u8f7b\u5ea6\u6dcb\u5df4\u7ec4\u7ec7\u7ec6\u80de\u6d78\u6da6\uff0c\u514d\u75ab\u7ec4\u5316\u68c0\u67e5\u53ef\u89c1\u8bb8\u591a\u6563\u5728\u7684T\u7ec6\u80de\u3001\u5076\u89c1B\u7ec6\u80de\u3002\u7ed3\u5408\u60a3\u8005\u53d1\u70ed\u75c5\u53f2\u3001\u7ea2\u6591\u9cde\u72b6\u76ae\u635f\u3001\u5168\u8840\u7ec6\u80de\u51cf\u5c11\u3001\u5916\u5468\u8840\u94c1\u86cb\u767d\u6c34\u5e73\uff1e10,000 ng\/mL\u7b49\u7279\u5f81\uff0c\u8fdb\u884c\u9274\u522b\u8bca\u65ad\uff1a<\/p>\n

    \n
  1. \u611f\u67d3\uff1a\u60a3\u8005\u75c5\u7a0b\u957f\u8fbe1\u5e74\uff0c\u611f\u67d3\u7684\u53ef\u80fd\u6027\u4f4e\uff0c\u4e88\u6392\u9664\uff1b<\/li>\n
  2. \u5fae\u8840\u7ba1\u75c5\u6027\u6eb6\u8840\u6027\u8d2b\u8840\uff1a\u60a3\u8005\u5916\u5468\u8840\u6d82\u7247\u4e0a\u7684\u88c2\u7ec6\u80de\u6570\u91cf\u5c11\uff0c\u5fae\u8840\u7ba1\u75c5\u6027\u6eb6\u8840\u6027\u8d2b\u8840\u7684\u53ef\u80fd\u6027\u4f4e\uff0c\u4e88\u6392\u9664\uff1b<\/li>\n
  3. DRESS\uff08\u836f\u7269\u53cd\u5e94\u4f34\u55dc\u9178\u6027\u7c92\u7ec6\u80de\u589e\u591a\u548c\u5168\u8eab\u6027\u75c7\u72b6\uff09\u7efc\u5408\u5f81\uff1a\u60a3\u8005\u65e0\u836f\u7269\u66b4\u9732\uff0cDRESS\u7efc\u5408\u5f81\u7684\u53ef\u80fd\u6027\u4f4e\uff0c\u4e88\u6392\u9664\uff1b<\/li>\n
  4. \u5de8\u566c\u7ec6\u80de\u6d3b\u5316\u7efc\u5408\u5f81\uff1a\u662f\u98ce\u6e7f\u6027\u75be\u75c5\u7684\u4e25\u91cd\u5e76\u53d1\u75c7\uff0c\u4e3b\u8981\u8868\u73b0\u4e3a\u6301\u7eed\u53d1\u70ed\u3001\u6dcb\u5df4\u7ed3\u53ca\u809d\u813e\u80bf\u5927\u3001\u5168\u8840\u7ec6\u80de\u51cf\u5c11\u7b49\uff0c\u60a3\u8005\u65e0\u81ea\u8eab\u514d\u75ab\u75c5\u75c5\u53f2\uff0c\u5178\u578b\u5de8\u566c\u7ec6\u80de\u6d3b\u5316\u7efc\u5408\u5f81\u7684\u53ef\u80fd\u6027\u4f4e\uff0c\u4e88\u6392\u9664\u3002<\/li>\n
  5. HLH\u7efc\u5408\u5f81\uff1a\u8be5\u60a3\u8005\u67091\u5e74\u53d1\u70ed\u75c5\u53f2\uff0c\u624b\u81c2\u548c\u817f\u90e8\u6709\u4e0d\u65ad\u6d88\u957f\u7684\u7ea2\u6591\u9cde\u72b6\u76ae\u635f\uff0c\u6709\u5168\u8840\u7ec6\u80de\u51cf\u5c11\u548c\u9ad8\u94c1\u86cb\u767d\u8840\u75c7\uff0c\u5916\u5468\u8840\u94c1\u86cb\u767d\u6c34\u5e73\uff1e10,000 ng\/mL\uff0c\u8003\u8651\u8bca\u65adHLH\u7efc\u5408\u5f81\u3002<\/li>\n<\/ol>\n

    HLH\u7efc\u5408\u5f81\uff1a\u53c8\u540d\u566c\u8840\u7ec6\u80de\u6027\u6dcb\u5df4\u7ec4\u7ec7\u7ec6\u80de\u589e\u591a\u75c7\uff08hemophagocytic lymphohistiocytosis syndrome\uff09\uff0c\u662f\u4e00\u7c7b\u7531\u539f\u53d1\u6216\u7ee7\u53d1\u6027\u514d\u75ab\u5f02\u5e38\u5bfc\u81f4\u7684\u8fc7\u5ea6\u708e\u75c7\u53cd\u5e94\u7efc\u5408\u5f81\uff0c\u5178\u578b\u7279\u5f81\u662f\u9ad8\u6c34\u5e73\u7684\u7ec6\u80de\u56e0\u5b50\uff0c\u4e34\u5e8a\u4ee5\u6301\u7eed\u53d1\u70ed\u3001\u809d\u813e\u80bf\u5927\u3001\u5168\u8840\u7ec6\u80de\u51cf\u5c11\u4ee5\u53ca\u9aa8\u9ad3\u3001\u809d\u3001\u813e\u3001\u6dcb\u5df4\u7ed3\u7ec4\u7ec7\u53d1\u73b0\u566c\u8840\u73b0\u8c61\u4e3a\u4e3b\u8981\u7279\u5f81\u3002\u7ee7\u53d1\u6027HLH\u662f\u7531\u611f\u67d3\u3001\u80bf\u7624\u3001\u98ce\u6e7f\u6027\u75be\u75c5\u7b49\u591a\u79cd\u75c5\u56e0\u542f\u52a8\u514d\u75ab\u7cfb\u7edf\u7684\u6d3b\u5316\u673a\u5236\u6240\u5f15\u8d77\u7684\u4e00\u79cd\u53cd\u5e94\u6027\u75be\u75c5\uff0c\u901a\u5e38\u65e0\u5bb6\u65cf\u75c5\u53f2\u6216\u5df2\u77e5\u7684\u9057\u4f20\u57fa\u56e0\u7f3a\u9677\u3002<\/p>\n

    HLH\u8bf1\u56e0\u7684\u9274\u522b\u8bca\u65ad\uff1a<\/p>\n

    HLH\u4e3b\u8981\u8bf1\u56e0\u5305\u62ec\uff1a<\/p>\n

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    \n\u2461\u6076\u6027\u80bf\u7624\uff1a\u4e3b\u8981\u662f\u8840\u6db2\u7cfb\u7edf\u80bf\u7624\uff0c\u5c11\u6570\u4e3a\u5b9e\u4f53\u80bf\u7624\u3002<\/p>\n

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    \u8be5\u60a3\u8005\u8840\u6db2\u7cfb\u7edf\u764c\u75c7\u7684\u5f71\u50cf\u5b66\u68c0\u67e5\u548c\u9aa8\u9ad3\u6d3b\u68c0\u7ed3\u679c\u5747\u4e3a\u9634\u6027\u3001\u65e0\u6dcb\u5df4\u7ed3\u80bf\u5927\u3001\u65e0\u9aa8\u9ad3\u53d7\u7d2f\uff0c\u8003\u8651\u7ed3\u5916\u6dcb\u5df4\u7624\u53ef\u80fd\uff0c\u75c5\u7406\u7c7b\u578b\u5e38\u89c1\u4e3aB\u6dcb\u5df4\u7ec6\u80de\u578b\uff0cT\u6dcb\u5df4\u7ec6\u80de\u578b\u6b21\u4e4b\u3002<\/p>\n

      \n
    1. \u7ed3\u5916\u6dcb\u5df4\u7624\uff1a\u5e38\u7d2f\u53ca\u80c3\u80a0\u9053\u3001\u76ae\u80a4\u3001\u9aa8\u9abc\u3001\u80be\u810f\u3001\u4e2d\u67a2\u795e\u7ecf\u7cfb\u7edf\uff0c\u5927\u591a\u5177\u6709FDG\u4eb2\u548c\u6027\uff0c\u65e0FDG\u4eb2\u548c\u6027\u6dcb\u5df4\u7624\u4e2d\u4ec5\u813e\u8fb9\u7f18\u533a\u6dcb\u5df4\u7624\u548cT\u7ec6\u80de\u6dcb\u5df4\u7624\u8868\u73b0\u4e3a\u7ed3\u5916\u6dcb\u5df4\u7624\u3002<\/li>\n<\/ol>\n

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      \uff082\uff09\u53ef\u80fd\u7684\u57fa\u7840\u8bf1\u56e0\u4e3aT\u7ec6\u80de\u6dcb\u5df4\u7624\u3002<\/p>\n

      2.\u5916\u5468T\u7ec6\u80de\u6dcb\u5df4\u7624\uff1a<\/p>\n

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      \uff082\uff09\u76ae\u4e0b\u8102\u819c\u708e\u6837T\u7ec6\u80de\u6dcb\u5df4\u7624\uff1a\u8868\u73b0\u4e3a\u7d2f\u53ca\u817f\u90e8\u3001\u624b\u81c2\u3001\u8eaf\u5e72\u548c\u9762\u90e8\u7684\u65e0\u75db\u6027\u76ae\u4e0b\u7ed3\u8282\u6216\u6591\u5757\uff0c\u7ea617%\u4f34HLH\uff0c\u76ae\u635f\u75c5\u7406\u68c0\u67e5\u7684\u5178\u578b\u7ed3\u679c\u4e3a\u76ae\u4e0b\u8102\u80aa\u5185T\u7ec6\u80de\u548c\u7ec4\u7ec7\u7ec6\u80de\u6d78\u6da6\uff0c\u901a\u5e38\u53ea\u7d2f\u53ca\u76ae\u4e0b\u8102\u80aa\uff1b\u8be5\u60a3\u8005\u7684\u7ed3\u8282\u7ea2\u6591\u8131\u5c51\u63d0\u793a\u75c5\u53d8\u7d2f\u53ca\u771f\u76ae\u548c\u8868\u76ae\uff0c\u4e88\u6392\u9664\u3002<\/p>\n

      \uff083\uff09\u539f\u53d1\u6027\u76ae\u80a4\u03b3-\u03b4 T\u7ec6\u80de\u6dcb\u5df4\u7624\uff1a\u7efc\u5408\u8003\u8651\u8be5\u60a3\u8005\u7684HLH\u75c7\u72b6\u3001\u5b9e\u9a8c\u5ba4\u68c0\u67e5\u7ed3\u679c\u3001\u65e0\u6dcb\u5df4\u7ed3\u80bf\u5927\u3001\u5b58\u5728\u76ae\u635f\u3001CD3\u3001CD4\u3001CD8\u3001CD56\u53caT\u7ec6\u80de\u53d7\u4f53\u03b1-\u03b2\u548c\u03b3-\u03b4\u7684\u514d\u75ab\u7ec4\u5316\u68c0\u6d4b\uff0c\u6700\u7ec8\u8bca\u65ad\u4e3a\u539f\u53d1\u6027\u76ae\u80a4\u03b3-\u03b4T\u7ec6\u80de\u6dcb\u5df4\u7624\u8bf1\u53d1\u566c\u8840\u7ec6\u80de\u6027\u6dcb\u5df4\u7ec4\u7ec7\u7ec6\u80de\u589e\u591a\u75c7\u3002<\/p>\n

      \u60a3\u8005\u4e8e\u542f\u52a8\u5316\u7597\u540e\u51fa\u73b0\u4e86\u547c\u5438\u8870\u7aed\u3001\u5f25\u6f2b\u6027\u80ba\u6ce1\u51fa\u8840\u3001\u8111\u51fa\u8840\u53ca\u8111\u759d\u5f62\u6210\uff0c\u6700\u7ec8\u6b7b\u4ea1\u3002<\/p>\n

      \"\"<\/p>\n

      (\u8bfb\u4e66\u62a5\u544a\uff1a\u6768\u807f\u822a \u00a0 \u00a0\u7f16\u8f91\uff1a\u5f20\u661f\u661f \u00a0 \u00a0\u5ba1\u6838\uff1a\u5218\u677e\u6865\/\u5218\u827e\u7136)<\/p>\n","protected":false},"excerpt":{"rendered":"

      A 66-Year-Old Man with Pancytopenia and Rash.pdf \u3010Case …<\/p>\n

      66\u5c81\u7537\u6027\u5168\u8840\u7ec6\u80de\u51cf\u5c11\u4f34\u76ae\u75b9<\/span> \u67e5\u770b\u5168\u6587 »<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[88],"tags":[],"_links":{"self":[{"href":"https:\/\/wp-cc.meddatas.com\/index.php?rest_route=\/wp\/v2\/posts\/5992"}],"collection":[{"href":"https:\/\/wp-cc.meddatas.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/wp-cc.meddatas.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/wp-cc.meddatas.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/wp-cc.meddatas.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=5992"}],"version-history":[{"count":3,"href":"https:\/\/wp-cc.meddatas.com\/index.php?rest_route=\/wp\/v2\/posts\/5992\/revisions"}],"predecessor-version":[{"id":6007,"href":"https:\/\/wp-cc.meddatas.com\/index.php?rest_route=\/wp\/v2\/posts\/5992\/revisions\/6007"}],"wp:attachment":[{"href":"https:\/\/wp-cc.meddatas.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=5992"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/wp-cc.meddatas.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=5992"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/wp-cc.meddatas.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=5992"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}