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患者,女,23岁,患者为会计,近15天一直感觉眼前模糊,偶有头晕、呕吐。5天前视物模糊症状加重,伴头晕、呕吐,呈持续性,不能缓解,无晕厥黑朦,无发热咳嗽咳痰,无胸闷胸痛呼吸因难等症状。当地就诊发现血压220/ 130mmHg,给予北京0号降压片1tid治疗,因症状逐渐加重转院。起病以来,患者精神饮食及睡眠尚可,大小便正常,体力体重无明显变化。否认糖尿病、高血压病史,否认结核、肝炎病史,无手术外伤史,输血史,无家族高血压病史。无肉眼血尿,无尿频尿急尿痛等病史。否认发热,关节疼痛。月经量正常。

T36.5℃,P110/分,R 22 /分,左上肢BP210/120mmHg,右上肢BP200/ 105mmHg,左下肢BP230/130mmHg,右下肢BP 220/120mmHg。神志清楚,面肌对称,伸舌居中,呼吸平稳,唇无发紺,气管居中,甲状腺未见肿大。双肺呼吸音清,未闻及干湿啰音。HR 110/律齐,未闻及杂音。腹平软,肝脾肋下未及,双肾区叩击有酸账感,腹部未闻及血管杂音。双下肢不肿,神经系统检查未见异常。

眼底检查:双眼视盘边界尚清,视盘附近血管周围灶状出血及棉绒斑,高血压视网膜病变Ⅲ期

提问2:根据目前的信息,该患者的诊断包括 [辅助检查结果]①尿常规:尿蛋白3+,尿潜血3+,尿白细胞2+,沉渣定量分析:尿红细胞定量424.8/μl,尿白细胞定量36.2/μl,尿上皮细胞定量34.0/μl,尿管型定量2. 89/μl。②血常规:红细胞2.64T/L,血红蛋白82g/L,血细胞比容23.5%,中性粒细胞74.5%,嗜酸性粒细胞0.4%,血小板112g/L ③肝功能肾功能电解质:直接胆红素1.4μmol/L,谷氨酰转肽酶5U/L,总蛋白57. 7g/L,清蛋白33.0g/L,清球比例1.3; BUN 18.86mmol/L,Cr456.4μmol/L,尿酸432. 9umol/L,钠135.0mmol/L,钾4. 7mmol/L,镁1.01mmol/L。④ENA(-)甲功三项(-);皮质醇8Am128、4Pm51,0Am194μg/L;CA3.45nmol/L ;RAS: PRA 7474Pmol/(L. h);Ang Ⅱ138Pmol/L, ALD213Pmol/L;抗G蛋白藕联受体抗体:抗α1受体抗体1 : 80,抗AT1受体抗体1: 40。⑤ECG:窦性心动过速。⑥CT平扫:颇脑未见明显异常。两侧肾上腺未见异常。⑦B超:双肾皮髓质与集合系统分界不清,呈肾病声像图改变。双背动脉阻力指数偏高,双肾血流信号减少。

多选题
2021-07-17 21:55
A、恶性高血压
B、眼底病变Ⅲ期
C、肾功能损害(氮质血症期)
D、原发性高血压合并急性肾损害
E、肾炎并发恶性高血压
F、肾上腺有关的继发性高血压
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正确答案
ABC

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