从“邪伏膜原”论治系统性血管炎肺部感染一例
Treatment of Lung Involvement in Systemic Vasculitis with Pulmonary Infection Based on the Theory of "Pathogenic Factors Hidden in Pleurodiaphragmatic Interspace"
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1.北京中医药大学东直门医院风湿病科,北京 101121
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胡杰,朱华超,王海隆.从“邪伏膜原”论治系统性血管炎肺部感染一例[DB/OL].(2023-11-13)[2023-11-13].http://cccl-tcm.cacm.org.cn/thesisDetails?columnId=43867497&Fpath=home&index=0&lang=zh
HU Jie,ZHU Huachao,WANG Hailong.Treatment of Lung Involvement in Systemic Vasculitis with Pulmonary Infection Based on the Theory of "Pathogenic Factors Hidden in Pleurodiaphragmatic Interspace"[J].,
胡杰,朱华超,王海隆.从“邪伏膜原”论治系统性血管炎肺部感染一例[DB/OL].(2023-11-13)[2023-11-13].http://cccl-tcm.cacm.org.cn/thesisDetails?columnId=43867497&Fpath=home&index=0&lang=zh DOI:
HU Jie,ZHU Huachao,WANG Hailong.Treatment of Lung Involvement in Systemic Vasculitis with Pulmonary Infection Based on the Theory of "Pathogenic Factors Hidden in Pleurodiaphragmatic Interspace"[J]., DOI:.
病史摘要,2,患者反复出现呼吸困难伴全身肌肉疼痛、乏力1年余,先后于当地医院、北京协和医院、我院诊治,考虑系统性血管炎肺脏受累,合并肺部感染所致。患者规律口服甲泼尼龙片抑制免疫,但肺脏受累仍进行性发展,并反复出现肺部感染。1月前,患者呼吸系统症状再次加重,并伴有肌肉酸痛、乏力,积极使用抗生素治疗,且口服甲泼尼龙片加量后,症状仍控制不佳,现为求进一步系统诊治,收入我科住院治疗。中医诊断 肺痹(痰湿内盛、郁闭膜原)。西医诊断 1.系统性血管炎,巨细胞动脉炎?2.风湿性多肌痛;3.肺部感染;4.肺间质纤维化;5.多颅神经麻痹;6.反流性食管炎;7.重度骨质疏松;8.脂肪肝,肝功能异常;9.腔隙性脑梗塞;10.肛门脱垂。干预措施 中医治疗以化痰祛湿、开达膜原为法,处以柴胡达原饮合三子养亲汤加减。西医治疗予注射用甲泼尼龙琥珀酸钠80 mg,静脉输液,每日一次(d1~d5)及注射用环磷酰胺0.4 g,静脉输液,每两周一次抑制免疫,并配合抗感染、补钙、促进钙吸收、抑酸护胃、护肝降酶、抗血小板聚集及对症治疗。疗效转归 患者呼吸困难、咳嗽咳痰、肌肉酸痛、吞咽困难、口干眼干、乏力等症状均明显好转,炎性及感染指标明显下降。
Summary of case history, The patient had recurrent dyspnea, general muscle pain, and fatigue for more than one year. He was diagnosed and treated in the local hospital, Peking Union Medical College Hospital, and our hospital. It was considered that lung involvement in Systemic Vasculitis and pulmonary infection. The patient took methylprednisolone tablets regularly to suppress immunity, but the lung involvement still progressed and pulmonary infections occurred repeatedly. One month ago, the patient's respiratory symptoms worsened again, accompanied by muscle soreness and fatigue. Although antibiotic treatment was actively used and the dose of methylprednisolone tablets was increased, the patient's symptoms were still poorly controlled. He is now hospitalized in our department for further systematic diagnosis and treatment.,TCM diagnosis, Lung Impediment (Syndrome of Phlegm and Dampness Retain in the Internal, Syndrome of Pathogenic Factors Hidden in the Pleurodiaphragmatic Interspace).,Western medicine diagnosis, 1.Systemic Vasculitis, Giant Cell Arteritis; 2.Polymyalgia Rheumatica; 3.Pulmonary Infection; 4.Pulmonary Interstitial Fibrosis; 5.Multiple Cranial Nerve Paralysis; 6.Reflux Esophagitis; 7.Severe Osteoporosis; 8.Fatty Liver Disease, Hepatic Dysfunction; 9.Lacunar Infarction; 10.Anal Canal Prolapse.,Therapeutic methods, Traditional Chinese medicine treatment is based on drying dampness and resolving phlegm, as well as opening the membrane source, using Membrane-Source-Opening Beverage and Three-Seed Filial Devotion Decoction. Western medicine treatment includes intravenous infusion of 80 mg of methylprednisolone sodium succinate once a day (d1-d5), and 0.4 g of cyclophosphamide for injection once every two weeks, along with anti-infection, calcium supplementation, and promotion of calcium absorption, inhibit gastric acid, protect liver, anti-platelet aggregation.,Clinical outcomes, The patient's symptoms such as dyspnea, cough and sputum, muscle aches, difficulty swallowing, dry mouth and eyes, and fatigue were significantly improved, and inflammatory and infection indicators were significantly reduced.
邪伏膜原证达原饮系统性血管炎肺间质纤维化肺部感染
Syndrome of pathogenic factors hidden in the pleurodiaphragmatic interspaceMembrane-source-opening beverageSystemic vasculitisPulmonary interstitial fibrosisPulmonary infection
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