丙硫氧嘧啶诱发抗中性粒细胞胞浆抗体相关性小血管炎7例临床分析  

Cases analysis on anti-neutrophil cytoplasmic antibody associated vasculitis induced by propylthiouracil

作　　者：董立新[1] 郭义娟 胡素芹[1] 

机构地区：[1]唐山市玉田县医院风湿免疫科和肾病科,唐山064100

出　　处：《世界临床药物》2011年第2期106-109,共4页World Clinical Drug

摘　　要：目的观察丙硫氧嘧啶诱发的抗中性粒细胞胞浆抗体(ANCA)相关性小血管炎的临床病理表现及诊治方法。方法对我院收治的7例丙硫氧嘧啶引起的ANCA相关性小血管炎病例进行回顾性分析,总结其临床表现、病理诊断结果及治疗方法。结果 7例患者均为女性,多表现为多系统受累,其中7例肾脏受累,4例肺部受累,关节痛、皮疹及发热也很常见。接受肾活检的5例患者中,4例新月体形成,1例肾小球轻微病变。抗体检测结果示7例为核周型ANCA(P-ANCA)阳性,抗甲状腺球蛋白抗体升高;3例抗核抗体(ANA)阳性。7例患者在明确诊断后均停用丙硫氧嘧啶,并接受糖皮质激素治疗,其中3例联合环磷酰胺治疗,临床症状均缓解。结论丙硫氧嘧啶可引起ANCA相关性小血管炎,及时停药并应用糖皮质激素或联合免疫抑制剂治疗,可改善预后。Objective To observe the clinical pathological characteristics and treatment of anti-neutrophil cytoplasmic antibody （ANCA） associated vasculitis induced by propylthiouracil. Methods Seven patients with ANCA associated vasculitis induced by propylthiouracil hospitalized in our hospital were evaluated retrospectively according to clinical manifestation, pathologic diagnosis and treatment. Results All of the seven patients were female. Multi-organ impairment was common with 7 patients involved in kidney and 4 patients involved in lung. Arthralgia, skin rash and fever were also common. In 5 patients accepted renal biopsy, 4 were crescent formation and 1 was kidney glomerulus mild lesion. Perinuclear-ANCA positive and elevation of anti-thyroglobulin antibody were observed in 7 patients. Antinuclear antibady （ANA） positive were observed in 3 patients. All of the 7 patients discontinued propylthiouracil administration after definite diagnosis and were treated with glucocorticoid, among them 3 patients were combined with cyclophosphamide. All of the 7 patients achieved clinical remission. Conclusion Propylthiouracil can induce ANCA associated vasculitis. Timely withdraw of propylthiouracil and administration of glucocorticoid as well as combining with immunosuppressive agents are important to prognosis improvement.

关 键 词：丙硫氧嘧啶 抗中性粒细胞胞浆抗体 小血管炎 糖皮质激素 环磷酰胺 

分 类 号：R977.14[医药卫生—药品] R593.2[医药卫生—药学]