病历摘要 患者,女,34岁,干部。因间断浮肿1年,加重伴全身皮肤黄染1周于1998年4月10日9时入院。患者缘于1年前无明显诱因出现晨起眼睑浮肿,继而出现少尿(400ml/日)及下肢浮肿,曾在我院及北京某医院化验及肾穿,病理检查诊断为“膜性肾病”应用强的松60mg/日治疗,浮肿逐渐缓解,尿量增加,恢复正常3个月后,强的松逐渐减量,现停用近1个月,眼睑及双下肢浮肿时有复发,休息后减轻。1周前患者因劳累后出现乏力,右上腹不适,巩膜及全身逐渐黄染,自觉发热(体温未测)少尿(约 400ml/日)眼睑及双下肢浮肿加重,曾在基层医院给予先锋Ⅵ(5g/日)消炎治疗3天,无明显疗效,复来我院就医。患者自述两年前体检时发现,HBsAg (+),但无症状,未进行治疗。否认有其他疾病病史。 体检,T37.8℃,P80次/分,R18次/分,BP16/ 12kPa,发育正常,营养良好,神志清晰,全身皮肤黄染,全身浅表淋巴结未触及肿大,眼睑轻度浮肿,巩膜明显黄染,双肺未见异常,心率96次/分,律规则,心尖部第一心音略减弱,未闻及杂音,腹平坦,右上腹压痛(±),肝肋弓下触及边,质中等, Murphy’s征(-),肝区叩痛(+),肠鸣音4次/分,双下肢明显可凹性浮肿,生理反射存在,病理反射未引出。 实验室检查:血常规RBC4.1×10~(12)/L, Hb120g/L,WBC7.5×10~9/L,N0.72,L0.29,PIt225 Patient summary, female, 34 years old, cadre. Due to intermittent edema 1 year, aggravating the body with yellow skin 1 week at 9:00 on April 10, 1998 admission. Patients due to no obvious incentive a year ago morning eyelid edema, and then there oliguria (400ml / day) and lower extremity edema, in our hospital and a Beijing hospital kidney test, pathological examination diagnosed as “membranous nephropathy” Application of prednisone 60mg / day treatment, edema gradually ease, urine output increased, returned to normal after 3 months, prednisone tapering, now disabled for nearly 1 month, eyelid and lower extremity edema recurrence, resting Reduce. 1 week ago due to fatigue after fatigue, right upper quadrant discomfort, sclera and body gradually yellow dye, consciously fever (body temperature not measured) oliguria (about 400ml / day) eyelid and lower extremity edema, had given the Pioneer Ⅵ (5g / day) anti-inflammatory treatment for 3 days, no significant effect, complex to our hospital for medical treatment. Patients reported physical examination two years ago, HBsAg (+), but no symptoms, no treatment. Denied history of other diseases. Physical examination, T37.8 ℃, P80 beats / min, R18 beats / min, BP16 / 12kPa, normal development, well-nourished, conscious, systemic skin yellow dye, systemic superficial lymph nodes without swelling, mild edema of the eyelid, sclera Clear yellow dye, no abnormal lungs, heart rate 96 beats / min, the rules of law, apical first heart sound slightly weakened, no smell and noise, flat belly, right upper quadrant tenderness (±) Moderate, Murphy’s sign (-), liver percussion (+), bowel sounds 4 beats / min, both lower extremity obvious concave edema, the presence of physiological reflex, the pathological reflex did not lead. Laboratory tests: blood RBC4.1 × 10-12 / L, Hb120g / L, WBC7.5 × 10-9 / L, N0.72, L0.29, PIt225