抗中性粒细胞胞浆抗体相关性小血管炎14例肺脏受累临床特征分析  

Clinical analysis of 14 cases with ANCA associated systemic vasculitis with lung damage

作　　者：姜德训[1] 白云静[1] 安娜 

机构地区：[1]100700北京军区总医院风湿科

出　　处：《国际呼吸杂志》2013年第16期1215-1217,共3页International Journal of Respiration

摘　　要：目的 探讨抗中性粒细胞胞浆抗体相关性小血管炎（AASV）患者肺脏受累的临床特征.方法 回顾性分析14例出现肺脏受累表现的AASV患者的临床资料,对肺脏受累的特点进行分析.结果 14例患者中肺部表现主要为咳嗽（92.86％）、咳痰（78.57％）、胸闷（64.29％）、气短（50.00％）以及弥散功能障碍（85.71％）、肺间质病变（57.14％）等；实验室检查均有C反应蛋白和血沉升高,大部分有白细胞升高（78.57％）、贫血（57.14％）、核周型抗中性粒细胞胞浆抗体（＋）（71.43％）等；肺外表现主要为发热（78.57％）、乏力（50.00％）、肾脏受累（71.43％）和消化道受累（42.86％）等；给予激素及免疫抑制剂治疗后病情好转11例（78.57％）,无效3例（21.43％）,其中2例死亡,1例进入终末期肾衰需血液透析治疗.结论 AASV临床表现复杂多样,肺脏受累多以咳嗽、咳痰症状为主,病变多见肺间质纤维化,肺外表现以发热、肾损害为主,早期诊断并及时治疗可改善预后.Objective To investigate the clinical characteristics of lung injury in patients with antineutrophil cytoplasmic antibody associated systemic vasculitis （AASV）. Methods The clinical data of 14 cases with lung involvement in patients with AASV were retrospectively analyzed, the characteristics of lung injury were summarized. Results Pulmonary manifestations were cough （92.86%）, expectoration （78.57%） ,chest tightness （64.29%）, shortness of breath （50.00%）, diffusion ventilation dysfunction （85.71%）, pulmonary fibrosis （57.14%）. Laboratory examination showed elevated erythrocyte sedimentation rate and C-reactive protein, anemia （57.14%）, pANCA （ ＋ ） （71.43%）. Extrapulmonary manifestations were fever （78.57%）, fatigue （50.00%）, renal injury （71.43%）, and digestive tract injury （42.86%）. 11 patients （78.57%） improved after the treatment of corticosteroid and immunosuppressive agent, three cases （21.43%） were invalid, including two cases died, one patient in end-stage renal failure need hemodialysis treatment. Conclusions The clinical manifestation of AASV is complicated with lung injury, mainly including cough and expectoration, interstitial pulmonary fibrosis, and extrapulmonary manifestations with fever and kidney damage, early diagnosis and timely treatment may improve the prognosis.

关 键 词：显微镜下多血管炎 肺损害 抗中性粒细胞胞浆抗体 

分 类 号：R593.9[医药卫生—内科学]