ANCA相关性系统性血管炎伴肾损伤的临床病理学研究  

ANCA associated systemic vasculits with renal involvement: a clinical and pathological analysis

作　　者：隋燕霞[1] 张冠军[1] 王鸿雁[1] 李晓峰[1] 杨喆[1] 

机构地区：[1]西安交通大学医学院第一附属医院病理科,西安710061

出　　处：《诊断病理学杂志》2014年第1期43-46,共4页Chinese Journal of Diagnostic Pathology

摘　　要：目的探讨中性粒细胞胞质抗体(ANCA)相关性系统性血管炎伴肾损伤患者的临床和病理特征。方法回顾性分析了16例ANCA相关性系统性血管炎伴肾损伤病例的临床及肾穿刺活检标本的病理资料,对其临床特点和病理特征及分型进行讨论。结果 16例中男性13例(81.25%),女性3例(18.75%),男女之比为4.33∶1。>50岁15例,只有1例为40岁。15例MPO-ANCA(pANCA)(+),1例PR3-ANCA(cANCA)(+)。>80%的患者肾功能不全,其中>80%患者合并肺部感染。肾穿刺活检病理:平均肾小球数为16.88±7.32个,15例为镜下多血管炎,1例为Wegerne肉芽肿,未见变应性肉芽肿血管炎。75%有肾小球毛细血管袢局灶性坏死和球性硬化,87.5%有新月体形成。结论本组ANCA相关性系统性血管炎伴肾损伤以老年男性为主,肾功能损害严重。肾组织活检病理学诊断可以为临床的治疗及判断预后提供可靠的形态学依据。Objective To evaluate the clinicopathological characteristics of antineutrophil cytoplasmic antibody （ANCA） associated systemic vasculitis with renal involvement. Methods The clinical and pathological data of renal biopsy from the First Affiliated Hospital of Xi＇ an Jiaotong University Medical College were assessed by retrospective analysis for the clinical characteristics and pathological types. Results In the 16 patients, 13 cases were male （ 81.25% ） , while 3 cases were female （ 18.75% ） , with male and female ratio of 4. 33 ： 1. 15 cases were diagnosed after 50 years old, and only one patient was 40 years old. 15 cases of ANCA types were MPO-ANCA （ pANCA ） and 1 case was PR3-ANCA （cANCA）. Renal dysfunction was found in 81.3% （ average SCr 324.43 ±263.85umol/L）, and 81.3% patients with lung infection. Renal biopsy showed average glomerular number was 16. 88 ±7.32, 15 cases were microscopic polyangitis, 1 case was Wegerner＇ s granulomatosis and no allergic granulomatosis angiitis. Glomerular segmental necrosis was 75% , crescent formation was 87.5%, global sclerosis was 75%. Conclusions In this study, ANCA associated systemic vasculitis with renal involvement is mainly elderly men and has severe renal dysfunction. Renal biopsy pathological diagnosis of ANCA associated systemic vaseulitis with renal involvement is a reliable method for clinical treatment and prognosis evaluation.

关 键 词：ANCA相关性系统性血管炎 肾损伤 病理 

分 类 号：R733[医药卫生—肿瘤]