原发性小血管炎肾损害92例临床分析  

Clinical analysis of 92 cases of primary small-vessel vacuities

作　　者：冯小平 郭宏 冯学亮[3] 

机构地区：[1]陕西省地矿医院内科,西安710014 [2]武警陕西总队机关门诊部 [3]西安交通大学第一附属医院肾内科

出　　处：《临床肾脏病杂志》2009年第7期310-312,共3页Journal Of Clinical Nephrology

摘　　要：目的探讨原发性小血管炎的临床表现和肾脏病理特点。方法回顾性分析92例原发性小血管炎的临床和病理资料。结果①临床呈多器官受累：为不规则发热、乏力、消瘦；浮肿、血尿、蛋白尿、肾功能减退；咳嗽、咯血、胸痛、肺部浸润；鼻塞伴有脓性分泌物；关节肿痛等。②光镜下，肾组织小血管壁节段性纤维素样坏死，多见新月体形成。免疫荧光示肾小球内无或仅有微量免疫球蛋白及补体c3沉积，3例伴有IgA沉积。③使用糖皮质激素联合细胞毒药物（环磷酰胺、来氟米特或霉酚酸酯），治疗有效率76％。结论原发性小血管炎并不少见，患者以中老年为主，显微镜下型多血管炎居多，抗中性粒细胞胞浆抗体（ANCA）检测有助于早期诊断及判断复发，及时治疗可延缓肾脏病变。Objective To analyze clinical manifestation, type and pathological changes of primary small-vessel vacuities. Methods Ninety-two patients with confirmed primary small-vessel vacuities were investigated retrospectively. Results （1）The clinical manifestations were non-specific symptoms of multi-system involvements which included irregular fever; edema and hematuria; proteinuria and renal hypo function; cough, hemoptysis, thoracalgia and lung infiltration; nasal obstruction and puru- lent secretion; joint swelling and painfulness. （2）The renal specimen biopsy demonstrated focal necrotizing and crescentic glomerulonephritis. No immunoglobulin or skeptophylaxis immunoglobulin or complement C3 was detected in immunofluorescent microscopic findings. （3）The curative effect was 76% when glucocorticoid was used in combination with cyclophop hamide or MMF in the treatment. Conclusion Primary small-vessel vacuities （ANCA related small-vessel vacuities） were commonly found in China, and the microscopic type multi vessel vacuities were even more common in clinic. The majority of the patients were elderly people. The clinical manifestations were comraonly found in the lung and kidney. An ANCA test is helpful in treatment can reverse nephropathy.

关 键 词：血管炎 抗中性粒细胞胞浆抗体 穿刺活检 

分 类 号：R543[医药卫生—心血管疾病] R692.31[医药卫生—内科学]