原发性ANCA相关小血管炎患者死因分析  

Analysis of the causes of death in patients with ANCA associated systemic vasculitis

作　　者：于峰[1] 陈旻[1] 赵明辉[1] 王海燕[1] 

机构地区：[1]北京大学第一医院肾脏内科暨北京大学肾脏病研究所,100034

出　　处：《北京医学》2007年第4期196-199,共4页Beijing Medical Journal

摘　　要：目的分析抗中性粒细胞胞浆抗体(ANCA)相关小血管炎患者的死亡原因,以进一步提高对该病的诊治水平,改善预后。方法回顾性总结近8年在我院确诊为ANCA相关小血管炎且死于住院期间的患者的临床及病理资料,并分析其死因。结果入组患者共15例,男9例,女6例;年龄41～84岁,平均(65±11)岁;诊断为显微镜下型多血管炎9例,韦格纳肉芽肿病6例;确诊前的病程为(13±3)个月(1～36个月);所有患者均出现全身多脏器受累。死亡原因:①与感染相关死亡14例,其中3例同时合并血管炎活动;单纯血管炎活动所致死亡1例(死于脑出血)。14例感染部位:肺部感染11例,其中合并腹膜炎1例、肠道感染1例、泌尿系感染1例;余3例中单纯腹膜炎2例,单纯肠道感染1例。感染菌种:细菌感染14例(大肠埃希菌5例次,其中产超广谱β-内酰胺酶阳性2例次;落菲不动杆菌、鲍曼不动杆菌、木糖氧化产碱杆菌各1例次;粪肠球菌3例次;绿脓杆菌2例次;克雷伯杆菌2例次;耐甲氧西林凝固酶阴性葡萄球菌4例次;高水平耐氨基糖苷类铅黄肠球菌1例次),其中4例合并真菌感染(曲霉菌感染1例次,白色假丝酵母菌感染4例次),1例合并巨细胞病毒感染。结论ANCA相关小血管炎患者住院期间死亡的首位原因为感染,可能与高龄、基础疾病多、重要脏器受累重及强化免疫抑制治疗等相关。Objective To analyze the causes of death in hospitalized patients with ANCA associated vasculitis. Methods Patients with ANCA associated vasculitis, hospitalized and died in our hospital in last 8 years were retrospectively studied. The clinical and pathological features and the causes of death were analyzed. Results Fifteen out of 183 （8.2%） hospitalized patients with ANCA associated vasculitis died during their hospitalization. The average age was（65＋ ll）years old （41-84 year）. There were nine males and six females; nine patients were diagnosed as microscopic polyangiitis and six patients were diagnosed as Wegener＇s granulomatosis. The average duration between the onset and diagnosis was （13＋3）months （1-36 months）. All patients had multi-organ involvement. Thirteen patients had lung in- volvement and all the patients had renal involvement. The direct causes of death were （1） Infection. The major pathogen was E.coli. （2） Active vasculitis. Conclusions The leading cause of death in patients with ANCA associated vasculitis during their hospitalization is infection. The contributing fators include older age, severer organ involvement and immunosuppressant treatment.

关 键 词：抗中性粒细胞胞浆抗体 血管炎 死因 

分 类 号：R593.9[医药卫生—内科学]