老年抗中性粒细胞胞浆抗体相关性血管炎诊治8例并文献复习  

Diagnosis and Treatment of Antineutrophil Cytoplasmic Autoantibody-Associated Vasculitides in 8 Elderly Patients and Literature Review

作　　者：丁怿虹[1] 陆刚[1] 陆伟[1] 张羽[1] 刘建军[1] 诸卫英[1] 唐建国[1] 

机构地区：[1]复旦大学附属上海市第五人民医院创伤急救危重医学中心,上海200240

出　　处：《中国临床医学》2015年第2期228-230,共3页Chinese Journal of Clinical Medicine

摘　　要：回顾分析8例以肺部感染为首发症状的抗中性粒细胞胞浆抗体相关性血管炎（antineutrophil cytoplasmic autoantibody‐associated vasculitides ，ANCA‐AAV）老年患者的临床资料，探讨以肺部感染症状为主要表现的ANCA‐AAV的临床特征与诊治方法。8例中6例患者接受甲泼尼龙1 mg／（kg· d）治疗4～6周，病情控制后改为泼尼松，逐渐减量，其中3例同时接受免疫抑制剂环磷酰胺2 mg／（kg · d）口服1年；1例加用雷公藤1 mg／（kg · d）治疗3个月；2例因出现肾功能衰竭病死，未用糖皮质激素治疗。8例患者中，除2例因肾功能衰竭死亡外，1例因呼吸功能衰竭死亡，5例患者经治疗后咳嗽、咳痰、贫血、乏力、肌肉酸痛等症状明显好转，体温恢复正常。因此，对于临床表现缺乏特异性且抗感染等疗效不佳的患者应尽早行 ANCA检测。糖皮质激素治疗能改善ANCA‐AAV患者的预后。To explore the clinical characteristics ,as well as diagnosis and treatment , of antineutrophil cytoplasmic autoantibody‐associated vasculitides （ANCA‐AAV ）with pulmonary infection as the initial manifestation , by analyzing the clinical data of 8 elderly patients with ANCA‐AAV with pulmonary infection as the initial manifestation .Six patients ,who had received treatment of methylprednisolone 1 mg/（kg ＆183; d） for 4 to 6 weeks ,switched over to tapering prednisone .Three of the six cases received immunosuppressive cyclophosphamide 2 mg/（kg ＆183; d） orally for 1 year simultaneously ,of which one case received tripterygium wilfordii 1 mg/（kg ＆183; d） in addition for 3 months .The other two cases did not receive glucocorticoid therapy due to death caused by renal fallure .Among the 8 patients ,apart from 2 patients died in renal fallure and one case of death due to respiratory fallure ,5 patients got significant improvement on symptoms as cough ,sputum ,anemia ,fatigue , muscle aches ,and their body temperature returned to normal .Thus ,ANCA assay should be performed as early as possible for patients who had no specific clinical manifestation and showed no significant improvement to anti‐infection treatment . Administration of glucocorticoid may improve the prognosis of patients with ANCA‐AAV .

关 键 词：抗中性粒细胞胞浆抗体相关性血管炎 糖皮质激素 环磷酰胺 

分 类 号：R543[医药卫生—心血管疾病]