抗中性粒细胞胞质抗体相关小血管炎患者抗体滴度与其临床特点及预后的相关性研究  

Correlation Between the ANCA Titer and Clinical Characteristics,Prognosis of Patients With AASV

作　　者：季中菊 王梅红[1] 李静[1] 米娜瓦尔.玉努斯 桑晓红[1] 

机构地区：[1]新疆医科大学第一附属医院,新疆乌鲁木齐市830054

出　　处：《中国全科医学》2016年第14期1642-1646,1652,共6页Chinese General Practice

摘　　要：目的分析抗中性粒细胞胞质抗体（ANCA）相关小血管炎（AASV）患者的临床表现、诊断、分类、实验室特征、治疗及转归;探讨ANCA滴度判断AASV患者病情活动的价值及滴度高低对治疗及转归的影响,以提高对该类疾病的认识。方法选取2010年1月—2014年12月新疆医科大学第一附属医院ANCA阳性且经临床表现、实验室检查确诊为AASV的患者117例,将其按照ANCA滴度分为低滴度组（≤100 RU/ml,n=61）和高滴度组（〉100RU/ml,n=56）,观察两组患者临床表现、实验室指标、治疗方案及转归。结果 117例患者中110例（94.0%）诊断为显微镜下多血管炎（MPA）,仅有7例（6.0%）诊断为肉芽肿性多血管炎（GPA）。低滴度组伯明翰血管炎活动性评分（BVAS）为（13.7±0.9）分,低于高滴度组的（18.3±0.8）分（t=3.890,P〉0.05）;高滴度组体质量下降发生率高于低滴度组（P〉0.05）;高滴度组蛋白尿、血肌酐升高发生率高于低滴度组（P〉0.05）;高滴度组皮肤改变发生率高于低滴度组（P=0.027）。两组血红蛋白、血小板计数、C反应蛋白（CRP）、C_3、C_4水平比较,差异均无统计学意义（P〉0.05）;高滴度组白细胞计数、红细胞沉降率均高于低滴度组（P〉0.05）;高滴度组病死率（32.1%,18/56）高于低滴度组（13.6%,8/61）（P〈0.05）。低滴度组平均生存时间为44.7个月〔SE=3.572,95%CI（37.703,51.706）〕,高滴度组平均生存时间为30.6个月〔SE=3.191,95%CI（24.390,36.899）〕。KaplanMeier生存曲线显示,低滴度组1年生存率为93.4%,5年生存率为75.5%;高滴度组1年生存率为59.9%,5年生存率为54.9%,高滴度组患者生存率低于低滴度组（χ^2=4.565,P=0.033）。结论 AASV患者ANCA高滴度者在病情活动度、肾脏受累及病死率方面较低滴度者更为严重,提示ANCA滴度在辅助疾病诊断、反映病情活动、指导治疗及判断预后方面有一定意义,应予以重视。Objective To analyze the clinical characteristics,diagnosis,systematization,laboratory characteristics,treatment and outcome of patients with ANCA- associated vasculitis（ AASV） and to discuss the significance of antibody titer for estimating the disease activity of vasculitis patients and the impact of antibody titer on the treatment and outcome,in order to improve the understanding of this disease. Methods A total of 117 patients hospitalized in the First Affiliated Hospital of Xinjiang Medical University from January 2010 to December 2014 who underwent ANCA test with positive results and were definitely diagnosed with AASV by clinical manifestation and laboratory test were enrolled. According to ANCA titer, the subjects were divided into low-titer group（ ≤100 RU / ml,n = 61） and high- titer group（ 〉100 RU / ml,n = 56）. Clinical manifestation,laboratory indexes, treatment regimen and outcome were observed. Results Among the 117 patients,110（ 94. 0%） patients were diagnosed as microscopic polyangiitis（ MPA）,and only 7（ 6. 0%） patients were diagnosed as granulomatous vasculitis（ GPA）. The BVAS score of low- titer group was（ 13. 7 ± 0. 9）,lower than high- titer group（ 18. 3± 0. 8）（ t = 3. 890,P〈 0. 001）. The two groups were not significantly different in the incidence rates of lack of strength,fever,arthralgia and myalgia（ P〉 0. 05）; high- titer group was higher than low- titer group in the incidence rate of body weight reduction（ P〈 0. 05）. The two groups were not significantly different in the incidence rates hematuresis and hypertension（ P〉 0. 05）; high-titer group was higher than low- titer group in the incidence rate of the increase of albuminuria and serum creatinine（ P〈 0. 05）. The two groups were not significantly different in the involvement rates of respiratory system,digestive system,cardiovascular system,eye-ear-nose- throat and nervous system（ P〉 0. 05）; high-titer group was higher than low-titer group in the incidence of sk

关 键 词：抗中性粒细胞胞浆抗体相关性血管炎 抗体滴度 临床分析 

分 类 号：R543[医药卫生—心血管疾病]