25例显微型多血管炎临床与病理分析  

Clinical and pathological analysis of 25 cases of microscopic polyangiitis

作　　者：刘宏发[1] 任昊[1] 王国保[1] 

机构地区：[1]南方医科大学南方医院肾内科,广东广州510515

出　　处：《南方医科大学学报》2011年第9期1632-1634,共3页Journal of Southern Medical University

摘　　要：目的分析显微型多血管炎（MPA）病例的临床及病理特点,提高诊治水平。方法回顾性分析2001年12月~2009月12月在南方医科大学南方医院肾脏病研究所住院确诊的25例MPA病例。结果 MPA起病时常表现为发热、肌肉关节疼痛、乏力、体质量减轻等非特异症状,伴蛋白尿、血尿及不同程度的肾功能不全。MPA肾损害的病理类型主要是局灶节段坏死性肾小球肾炎或寡免疫性新月体性肾炎。及时给予免疫抑制治疗可以遏制甚至逆转病情。结论 MPA早期症状非特异,容易误诊,检查血抗中性粒细胞胞浆抗体等指标,及时行肾活检有助于尽早明确诊断。若确诊为MPA,则应开始强有力的免疫抑制治疗,必要时行血浆置换,并仔细监测病情活动情况及药物毒副作用,及时调整用药,否则将影响预后。Objective To analyze the clinical and pathological features of microscopic polyangiitis（MPA） to improve the diagnosis and treatment of the disease.Methods Twenty-five cases of MPA were retrospectively analyzed.Results The onset symptoms of MPA,often nonspecific,included fever,muscle and joint pain,fatigue,loss of weight,etc,with varying degrees of proteinuria,hematuria and renal insufficiency.The pathological types revealed by renal biopsy were mainly focal segmental necrotizing glomerulonephritis or pauci-immune crescentic glomerulonephritis.Timely immunosuppressive therapy could improve the outcome.Conclusion The early symptoms of MPA are often nonspecific to easily result in misdiagnosis.Examination of ANCA titers and timely renal biopsy are helpful to establish an early diagnosis.Immune suppression therapy and plasma exchange when necessary should be initiated after the establishment of the diagnosis.The disease activity and drug toxicity should be carefully monitored to improve the prognosis.

关 键 词：显微型多血管炎 新月体性肾小球肾炎 局灶节段坏死性肾小球肾炎 

分 类 号：R692[医药卫生—泌尿科学] R593.2[医药卫生—外科学]