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在老年患者的经验性葡萄糖皮质类药物管理的风险的炎症来源不明:一个病例报告
Takashi Yamane1, Chiharu Miyamoto
1Department of Rheumatology, Kakogawa Central City Hospital, Kakogawa, Japan.
Medicine
|April 21, 2025
概括
经验性葡萄糖皮质激素 (GC) 治疗老年患者的炎症来源不明 (IUO) 可以掩盖潜在的恶性瘤,并导致严重的并发症,如静脉血栓塞栓症 (VTE). 在开始这种人群的GC治疗之前,对恶性瘤和VTE进行彻底的查至关重要.
科学领域:
- 老年医学 老年医学
- 内部医学 内部医学
- 在瘤学瘤学.
背景情况:
- 老年人的未知起源炎症 (IUO) 通常归因于非传染性炎症性疾病.
- 经验性葡萄糖皮质体 (GC) 治疗对于IUO是常见的,但具有骨质疏松症和静脉血栓栓塞 (VTE) 等风险.
- 使用GC可以延迟潜在恶性瘤的诊断,而VTE可以模仿IUO.
研究的目的:
- 突出实证葡萄糖皮质激素 (GC) 治疗在老年患者的潜在风险,未知来源的炎症 (IUO).
- 强调在开始GC治疗之前对恶性瘤和血栓塞栓症进行全面查的重要性.
主要方法:
- 一个84岁的妇女病例报告显示,她患有长期发烧和厌食症.
- 对于疑似非传染性炎症疾病的GC初始治疗导致了包括VTE和胃腺癌的延迟诊断在内的并发症.
- 诊断评估包括成像和内镜,证实I期胃腺癌.
主要成果:
- 患者在GC治疗期间发生了静脉动脉突和压缩骨折.
- 在出现并发症后,诊断出I期胃腺癌.
- 手术后一年,患者没有出现恶性瘤复发,炎症标志物正常化,没有进一步的血栓塞栓事件.
结论:
- 老年IUO患者经验性GC治疗可能导致严重并发症和延迟诊断.
- 恶性病和VTE查应在GC启动之前进行.
- 如果IUO患者出现VTE,建议重新评估恶性瘤,即使有其他危险因素.
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