ANCA相关性血管炎肺脏受累的临床特点及危险因素分析  

The clinical features and risk factors analysis of ANCA associated systemic vasculitis with pulmonary involvement

作　　者：韩肖晓 桂淑玉[1] 

机构地区：[1]安徽医科大学第一附属医院呼吸内科,安徽合肥230022

出　　处：《临床肺科杂志》2016年第2期248-252,共5页Journal of Clinical Pulmonary Medicine

摘　　要：目的探讨ANCA相关性血管炎（AASV）肺脏受累的临床特点并分析其危险因素。方法回顾性分析安医大一附院2010年1月至2015年1月住院确诊的201例ANCA相关性血管炎临床资料,其中肺脏受累组93例和非肺脏受累组（对照组）108例,比较两组临床表现及辅助检查资料,运用Logistic回归模型进行危险因素分析。结果 201例患者中,男性75例,女性126例,平均年龄（62.64±14.89）岁,死亡2例,自动出院5例。两组在性别、纳差、乏力、体重下降、关节痛、肌痛差异无统计学意义;在白细胞计数、中性粒细胞比例、血红蛋白水平、血清白蛋白水平、CRP、ANCA滴度差异有统计学意义（P〈0.05）。Logistic多因素分析结果显示：低蛋白血症（OR=0.593,95%CI 0.385~0.914,P〈0.05）和C反应蛋白升高（OR=1.302,95%CI 1.087~1.559,P〈0.05）的患者更易合并肺脏受累。肺脏受累组影像学表现半数以上为间质性改变及斑片状、条索影。结论 AASV患者肺脏受累临床表现缺乏特异性,肺部影像学以间质性改变及斑片状、条索影为主,低白蛋白血症和C反应蛋白升高合并肺脏受累的风险高,临床上应予以重视。Objective To analyze the clinical features and risk factors of ANCA-associated systemic vasculitis with pulmonary involvement. Methods 201 AASV patients in our hospital from January 2010 to January 2015 were selected,and they were divided into the pulmonary involvement group（ 108 cases） and the control group（ 93cases） according to their clinical features. The clinical data were analyzed retrospectively and the correlative facts were performed by using logistic regression models. Results Of 201 AASV patients,75 cases（ 37. 31%） were male and 126 cases（ 62. 69%） were female. Their average ages were（ 62. 64 ± 14. 89）. There were 2 cases of death reported and 5 cases discharged without medical advice. There was no statistically significant differences in sex proportion,poor appetite,fatigue,weight loss,joint pain,and muscle pain between the two groups. There were significant differences in white blood cell count,proportion of neutrophils,hemoglobin,serum albumin,CRP,and ANCA concentration between the two groups（ P〈0. 05）. Multivariate logistic regression analysis showed that hypoproteinemia（ OR = 0. 593,95% CI 0. 385 ~ 0. 914,P〈0. 05） and elevated C-reactive protein（ OR = 1. 302,95% CI 1. 087 ~1. 559,P〈0. 05） were the risk factors of pulmonary involvement. More than half of the imaging characteristics of pulmonary involvement were interstitial change,patchy and funicular shadow. Conclusion The clinical manifestations of AASV with pulmonary involvement are lack of specificity. The main characteristics of lung imaging are interstitial change,patchy and funicular shadow. The AASV patients combined with hypoproteinemia and elevated C-reactive protein should be considered as the high risk for AASV pulmonary involvement. Therefore,the clinicians should pay more attention to those complications of AASV patients.

关 键 词：血管炎 肺脏 C反应蛋白 低白蛋白血症 危险因素 

分 类 号：R593.2[医药卫生—内科学]