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患者女,38岁.因四肢麻木、进行性乏力、活动障碍伴吞咽、发音无力3天于1992年2月12日入院,入院前3月始持续出现烦渴、多饮、多尿.否认肾炎、高血压及糖尿病史.于4～5年前始双手指关节反复肿胀酸痛.经当地医院诊断力“类风湿性关节炎”.又于2年前始常感双眼及口腔干燥,反复眼结膜红肿、刺痛及异物感.体检:T37C,P78次/分,R18次/分,BP15/9kPa.发育正常,营养中等,声音低弱.两眼微陷,结膜充血、分泌物较多,有少许粘液丝.口腔及舌粘膜表面干燥,唾液甚少,甲状腺不肿大,心肺听诊正常,肝脾未触及,双手近端指关节轻度梭形肿大,四肢肌力0级,腱反射消失,病理神经反射阴性.血钾(入院当日)1.5mmol/L,尿素氮及肌酐正常.血CO_2CP11.5mmol/L,血气分析:pH7.209.AB13.1mEg/L,BE13.5mEp/L,类风湿因子(+),抗核抗体(一),血IgG153.7g/L.IgAl,51g/L,IgM1.07g/L.蛋白电泳:白蛋白61.8%,α_1及α_2
Female patient, aged 38. Due to limb numbness, progressive fatigue, dyskinesia with swallowing, speechless 3 days admitted on February 12, 1992, 3 months before admission continued to appear polydipsia, polydipsia, polyuria. Denied nephritis , History of hypertension and diabetes .Under 4 to 5 years ago, both hands and joints repeatedly swollen soreness.After diagnosis by the local hospital, “rheumatoid arthritis.” And 2 years ago, often binocular and dry mouth, conjunctival Physical examination: T37C, P78 beats / min, R18 beats / min, BP15 / 9kPa. Normal development, moderate nutrition, low voice. Two subtle trauma, conjunctival congestion, secretions are more A little mucus silk. Oral and lingual mucosa surface dry, saliva is very small, thyroid enlargement, normal cardiopulmonary auscultation, liver and spleen not touched, both hands proximal mild joint swollen fusiform, muscle strength 0 limbs, tendon reflex disappeared , Pathological nerve reflex negative.Klenella (admission day) 1.5mmol / L, urea nitrogen and creatinine normal blood CO_2CP11.5mmol / L, blood gas analysis: pH7.209.AB13.1mEg / L, BE13.5mEp / L, Rheumatoid factor (+), antinuclear antibody (a), blood IgG153.7g / L.IgAl, 51g / L, IgM1.07g / L. Protein electrophoresis: albumin 61.8%, α_1 and α_2