左颈总动脉炎误诊为频发心绞痛1例.docVIP

左颈总动脉炎误诊为频发心绞痛1例 　　[摘要] 大动脉炎是一种以损害人体中膜为主的全身性动脉炎症。该病因累及动脉部位不同，临床表现也复杂多变，极易造成误诊。本文报道1例2014年12月在本院就诊的大动脉炎患者，因起病症状、病情发作特点与心绞痛极其相似而误诊，追朔病史发现此病例多次误诊、致使病情迁延。本文通过对其分析，进一步阐述该病的临床特点及误诊原因，提醒医师对本病的认识，以便更好地服务于患者。 　　[关键词] 大动脉炎；心绞痛；误诊 　　[中图分类号] R543.4 [文献标识码] A [文章编号] 1674-4721（2015）06（a）-0168-03 　　One case of left common carotid arteritis misdiagnosed as frequent-occurrence of angina pectoris 　　CHEN Run-wei 　　Department of Chronic Diseases，Fuyu People′s Hospital in Tsitsihar City，Tsitsihar 161200，China 　　[Abstract] Takayasu arteritis refers to a general arterial inflammation mainly damaging tunica media.Due to different arterial parts involved in the disease，the clinical manifestations are also complicated and changeable，which easily lead to misdiagnosis.One patient diagnosed as Takayasu arteritis and visited our hospital in December 2014 was reported in the paper.Onset of symptoms and characteristics of disease attack were similar to those in angina pectoris and would be misdiagnosed.When asking past medical history，the patient was misdiagnosed for several times resulting in delay.Based on the analysis of disease conditions，the clinical characteristics and causes of misdiagnosis in the disease were further elaborated.Meanshile， awareness of the disease was reminded for other physicians in order to offer better services for patients. 　　[Key words] Takayasu arteritis；Angina pectoris；Misdiagnosis 　　大动脉炎在临床上男性发病少见[1]，本病以累及大、中动脉及其分支的慢性非特异性炎症引起不同部位动脉狭窄或闭塞，出现相应部位缺血表现[2]。大动脉炎病因尚未明确，与机体发生免疫功能紊乱及细胞因子的炎症反应有关，是以节段性中膜损害为主的全动脉炎[3]。临床表现多样，如认识不足易误诊。现将本院近期收治1例因起病症状、病情发作特点酷似心绞痛，而造成误诊、致使病情迁延两年多患者进行总结。 　　1 病例资料 　　患者，男，44岁，农民。2014年12月4日因心前区疼痛就诊于本院急诊科，追问病史：患者平素身体健康，有烟酒不良嗜好。初诊距今2.5年左右，患者因胸闷、气短伴心前区疼痛就诊于当地医院，按“心绞痛”进行治疗，效果不佳。后转入多家医院进行诊治，多以“心肌炎、冠心病、酒精性心肌病、淋巴瘤、心脏神经官能症、肋间神经痛”等治疗。出院后在家不规则用药（具体用药不详），病情时好时坏。6个月前曾驾车因晕厥出现车祸致左小腿骨折。近半年症状持续加重，出现食欲下降、乏力、心烦易怒、多汗、左背酸痛等症状。心前区疼痛症状的频率增加，几乎每天出现，且位置较固定，左肩及左上肢的放射伴随症状亦有所加重，出现颈部及口周的麻木感。查体：T36.9℃，P90/min，R21/min，BP150/89 mm Hg[4]。体态稍胖，表情焦虑，皮肤及淋巴结无异常。眼球稍突，耳鼻无异常。颈