Rasmussen N
Associate Professor, Department of Otorhinolaryngology-Head and Neck Surgery, Rigshospitalet, Copenhagen, Denmark.
Curr Opin Rheumatol. 2001 Jan;13(1):3-11. doi: 10.1097/00002281-200101000-00002.
A diagnosis of Wegener granulomatosis requires granulomatous manifestations in the respiratory tract. With the increasing use of antineutrophil cytoplasmic autoantibodies as a diagnostic tool, Wegener granulomatosis is diagnosed earlier than in the past, and not infrequently when only ear, nose and throat manifestations are present, placing the otorhinolaryngologist in a central role in diagnosis and management. Diagnostic biopsies should be obtained from active lesions in the nose and paranasal sinuses and concomitant infection should be identified. Because of the apparent relation between infection and activation of disease, the management of infections-especially those due to Staphylococcus aureus-requires special attention. The increasing numbers of early cases identified warrants further investigations of whether less toxic treatment regimens will be of advantage in such cases. Medical and surgical treatment of the acute and chronic manifestations presents specific problems because of altered immune competence, prevalent superinfection, and tissue destruction, and is therefore best taken care of by specially dedicated otorhinolaryngologists.
韦格纳肉芽肿病的诊断需要呼吸道出现肉芽肿性表现。随着抗中性粒细胞胞浆自身抗体作为一种诊断工具的使用越来越多，韦格纳肉芽肿病比过去更早被诊断出来，而且在仅出现耳鼻喉表现时也并不罕见，这使得耳鼻喉科医生在诊断和治疗中处于核心地位。诊断性活检应取自鼻腔和鼻窦的活动性病变，并应识别出合并感染。由于感染与疾病激活之间存在明显关联，因此感染的治疗，尤其是由金黄色葡萄球菌引起的感染，需要特别关注。早期病例数量的增加促使人们进一步研究毒性较小的治疗方案在此类病例中是否具有优势。由于免疫功能改变、普遍存在的二重感染和组织破坏，急性和慢性表现的药物和手术治疗存在特定问题，因此最好由专门的耳鼻喉科医生进行处理。
