以咽喉疼痛为首发症状的白塞病临床诊治分析

刁文雯; 朱莹莹; 陈兴明; 祝小莉

doi:10.13201/j.issn.2096-7993.2023.02.010

以咽喉疼痛为首发症状的白塞病临床诊治分析

- 中国医学科学院北京协和医学院北京协和医院耳鼻咽喉科(北京，100730)
基金项目:
中央高水平医院临床科研业务费资助(No:2022-PUMCH-B-094)

详细信息

通讯作者: 祝小莉，E-mail：zhuxiaolipumc@gmail.com

中图分类号: R597.9; R766.1

收稿日期: 2022-10-08

刊出日期: 2023-02-03

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

- Department of Otorhinolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China

More Information

Corresponding author: ZHU Xiaoli, E-mail: zhuxiaolipumc@gmail.com

Received Date: 08 October 2022

Publish Date: 03 February 2023

摘要

摘要: 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。
- 白塞病 /
- 咽喉疼痛 /
- 临床诊治
Abstract: Objective To summarize the clinical and diagnostic characteristics of Behçet'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 Behçet'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 Behçet'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.
- Behçet's disease /
- sore throat /
- clinical diagnosis and treatment

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图 1 1例患者电子喉镜检查

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图 2 1例咽喉部多发溃疡患者电子喉镜检查

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图 3 1例吞咽困难患者电子鼻咽喉镜检查

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图 4 典型病例咽喉溃疡治疗前后电子鼻咽喉镜检查对比

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表 1 以咽喉疼痛为首发症状的患者白塞病临床特点例(%)

临床特点	总例数(n=28)	男性(n=22)	女性(n=6)
咽喉症状
喉溃疡	15(53.6)	15(68.2)	0(0)
下咽溃疡	14(50.0)	14(63.6)	0(0)
口咽溃疡	25(89.3)	19(86.4)	6(100.0)
口腔溃疡	28(100.0)	22(100.0)	6(100.0)
咽喉粘连	8(28.6)	6(27.3)	2(33.3)
吞咽困难	3(10.7)	2(9.1)	1(16.7)
呼吸困难	2(7.1)	2(9.1)	0(0)
咽喉外症状
外阴溃疡	21(75.0)	15(68.2)	6(100.0)
皮肤损害	18(35.7)	18(81.8)	0(0)
眼部病变	11(39.3)	9(40.9)	2(33.3)
神经系统累及	3(10.7)	2(9.1)	1(16.7)
关节累及	4(14.3)	4(18.2)	0(0)
消化系统累及	1(3.6)	1(4.5)	0(0)
针刺试验阳性	8(28.6)	8(36.4)	0(0)

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