41例抗中性粒细胞胞浆抗体相关性血管炎临床分析

    Clinical analysis of 41 cases of antineutrophil cytoplasmic antibody associated vasculitis

    • 摘要: 目的 分析抗中性粒细胞胞浆抗体(ANCA)相关性血管炎(AAV)发病的临床特点。方法 选取三峡大学第一临床医学院2012年1月至2017年1月住院诊断为ANCA相关性血管炎患者41例,分析其临床特征。结果 患者男女比例为1.05∶1,平均年龄(61.6±14.4)岁,患者年龄≥65岁者占48.8%。从发病到确诊时间为5~2 160 d,平均为(136.68±344.79) d。41例患者中,39例核周型ANCA(P-ANCA)/抗髓过氧化物酶(MPO)抗体阳性,1例胞浆型ANCA(C-ANCA)/抗蛋白酶3(PR3)抗体阳性,ANCA阴性1例。AAV临床表现复杂多样,肾脏受累表现占100%,呼吸道症状和全身非特异性症状其次(占61%),其累及肺、肾的程度不一,且病变发生时间不一致。AAV治疗缓解率为69.2%,病死率为9.8%。结论 AAV累及多系统且病变程度不一,结合临床症状及ANCA检测有助于早期诊断,临床表现符合AAV而ANCA检测阴性时,应及时行病理活检。治疗需联合各系统评估病变程度后选择相应治疗手段。

       

      Abstract: Objective To analyze clinical characteristics of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV).Methods A total of 41 patients with AAV admitted to China Three Gorges University from January 2012 to January 2017 were selected and analyzed.Results The ratio of male:female was 1.05:1, and the average age was (61.6±14.4) years old. 48.4% of them were older than 65 years old. The time from disease onset to diagnosis was 5 to 2 160 days, with an average of (136.68±344.79) days. Of the 41 patients, 39 cases were positive for perinuclear ANCA (P-ANCA)/anti myeloperoxidase (MPO) antibody and 1 positive for cytoplasmic ANCA (C-ANCA)/anti protease 3 (PR3) antibody positive, and 1 negative for ANCA. The clinical manifestations of AAV were complex and varied. The manifestations of renal involvement accounted for 100%, followed by respiratory symptoms and systemic nonspecific symptoms, accounting for 61%. The degree of involvement of the lungs and kidney was different, and the time of the disease was inconsistent. The remission rate of AAV was 69.2% and the fatality rate was 9.8%. The degree of AAV involving the lung and kidney was different, and the time of the occurrence of lesions was inconsistent.Conclusions AAV involves multiple systems with varying degrees of lesions. Combination of clinical symptoms and ANCA detection is helpful for early diagnosis. Under the situation that the clinical manifestation is in accordance with AAV while the ANCA test is negative, the pathological biopsy should be done in time. The appropriate treatment is chosen after systematically assessing the degree of lesions.

       

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