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成人血管炎管理概述

Author
Peter A Merkel, MD, MPH
Section Editor
Eric L Matteson, MD, MPH
Deputy Editor
Monica Ramirez Curtis, MD, MPH
Translators
朱剑, 主任医师，副教授

引言

血管炎定义为血管壁有白细胞浸润并伴有血管壁结构的反应性损害。一般来说，具体的不同类型血管炎所累及的血管大小、类型和部位有所不同。这类疾病通常较为严重，有时甚至可以致命，因此需要及时发现和治疗。

单个或多个器官可出现症状性受累。一些特异性临床表现能够提示患者可能为某种特定类型的血管炎，但不同类型血管炎间也存在许多共同特点。由于血管炎的临床表现范围很广，使得这类复杂疾病的管理尤为困难。

本专题将对血管炎的处理方法进行概述。具体血管炎类型的治疗推荐将各自单独总结(参见下文‘疾病特异性治疗’)；不同血管炎的分类和临床表现，以及对疑似血管炎患者的处理方法概述参见其他专题。 (参见“成人血管炎的分类及诊断方法”)

治疗方法

血管炎的治疗大体原则与其他许多系统性自身免疫性风湿疾病相似，但具体的治疗方案取决于特定疾病的性质和严重程度(参见下文‘疾病特异性治疗’)。血管炎的处理方案一般包括以下方面：

●诱导缓解–初始治疗的目标是诱导疾病缓解。初始治疗通常包括使用中至高剂量的糖皮质激素，某些类型的血管炎还要加用免疫抑制药物。血管炎的初发通常很快，诊断延迟或未能发现疾病严重程度并控制病情进展会导致严重的病况，对于某些类型的血管炎来说可能导致死亡。因此，血管炎初始治疗阶段可能比后续治疗阶段的治疗强度更大，包括使用较高剂量药物或药物毒性风险较大的药物。

          

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Literature review current through: 2017-06 . | This topic last updated: 2015-10-14.
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