显微镜下多血管炎29例肺部病变特点分析  

Characteristics of lung involvement in 29 microscopic polyangiitis patients.

作　　者：李俊[1] 蔡柏蔷[1] 

机构地区：[1]中国医学科学院北京协和医院呼吸内科,北京100730

出　　处：《中国实用内科杂志》2008年第11期949-951,共3页Chinese Journal of Practical Internal Medicine

摘　　要：目的分析显微镜下多血管炎(MPA)的肺部病变特点,及其对治疗和预后的影响。方法回顾性分析2006年1月至2007年12月北京协和医院住院的29例MPA患者的临床资料,对其肺部受累和肺部感染的特点进行分析。其中男14例,女15例;平均发病年龄(63.7±10.1)岁。结果患者中28例(96.6%)有肺部受累,有症状者20例(69.0%),有体征者15例(51.7%)。影像学上主要表现为肺间质纤维化和肺泡出血。实验室检查中血气异常17例(17/27),心脏超声诊断肺动脉高压5例(5/18),肺功能异常7例(7/10),支气管镜肺泡灌洗液异常4例(4/6)。29例患者中肺泡出血10例(34.5%),合并肺部感染18例(62.1%)。死亡患者10例(34.5%),其中2例死于弥漫性肺泡出血,8例死于肺部感染。结论MPA患者肺部受累和肺部感染发生率高,临床表现差异很大。肺部感染和弥漫性肺泡出血为MPA患者主要死亡原因,需要临床高度重视。Objective To investigate the characteristics of lung involvement in microscopic pulyangiitis （MPA）patients and its influence on treatment and prognosis. Methods From Jan 2006 to Dec 2007,29 patients were diagnosed with MPA in Peking Union Medical College Hospital. Their clinical data, including clinical manifestations, radiologic and labo- ratory test results, were retrospectively analyzed. Results The patients included 14 males and 15 females. The mean age was（63. 7 ± 10. 1 ）years;28 patients（96. 6% ） were involved in the lung;20 patients（69.0% ） had respiratory symptoms and 15 patients（51.7% ）had respiratory signs. Two kinds of patterns were found in radiology：hemorrhage and fibrosis. Seventeen patients （17/27 ）were hypoxemia in room air blood gas analysis. Five patients （5/18）were diagnosed with pulmonary hypertension by echocardiograghy. Seven patients （7/10）were abnormal in lung function test. Four patients （4/6） were abnormal in BALF. Ten patients （34. 5 % ）were diagnosed with alveolar hemorrhage and 18 patients （62. 1% ）were complicated with pulmonary infection. Totally 10 patients（34. 5% ）died,2 patients of diffuse alveolar hemorrhage and 8 of pulmonary infection. Conclusion Most MPA patients have pulmonary involvement and the clinical manifestations vary. There is a high mortality in MPA patients and the main eauses are pulmonary infection and diffuse alveolar hemorrhage.

关 键 词：显微镜下多血管炎 肺部受累 肺部感染 

分 类 号：R5[医药卫生—内科学]