Pickert Amanda
Cutis. 2012 May;89(5):E1-3.
My approach to vasculitis and vasculopathy includes: (1) Determine the level of care the patient needs. If I am not sure, I will order a basic laboratory evaluation while I decide on the more specific laboratory tests to order and of course do a skin biopsy. (2) Determine if the eruption represents vasculitis or vasculopathy. The presence of livedo reticularis or retiform purpura points toward vasculopathy, but keep in mind the overlap, especially with the ANCA-associated vasculitides. (3) If vasculitis, rule out the secondary causes (ie, infection, drug reactions, malignancy, connective-tissue disorders) first. (4) Determine the size of the vessel involvement and the organ systems involved, which will narrow down the differential diagnosis. Although no one approach works for everyone, I find this method to be simple and keeps you organized when tackling the workup of vasculitis and vasculopathy.
(1) 确定患者所需的护理级别。如果我不确定，我会在决定进行更具体的实验室检查并当然进行皮肤活检时，安排一次基本的实验室评估。(2) 确定皮疹是代表血管炎还是血管病。网状青斑或花斑状紫癜提示血管病，但要记住存在重叠情况，尤其是与抗中性粒细胞胞浆抗体相关血管炎。(3) 如果是血管炎，首先排除继发原因（即感染、药物反应、恶性肿瘤、结缔组织病）。(4) 确定受累血管的大小和受累的器官系统，这将缩小鉴别诊断范围。虽然没有一种方法适用于所有人，但我发现这种方法很简单，在处理血管炎和血管病的检查时能让你保持条理清晰。
