ANCA相关性血管炎肾脏及其他系统损害的临床和病理与预后的相关研究  

Clinicopathologic characteristics of kidney and other organs in ANCA-associated vasculitis patients and outcomes and risk factors

作　　者：刘国平 王春艳 徐丽斌 曹赛霞 郭艳 

机构地区：[1]内蒙古自治区人民医院肾内科,呼和浩特010010

出　　处：《临床肾脏病杂志》2016年第8期457-461,共5页Journal Of Clinical Nephrology

基　　金：内蒙古自治区卫生厅医疗卫生科研计划项目(No.2006048);内蒙古自治区医疗卫生学科建设项目(No.20081304)

摘　　要：目的探讨抗中性粒细胞胞浆抗体相关性血管炎（antineutrophil cytoplasmic antibody-associated vasculitis，AAV）肾损害及其他系统损害患者的临床和病理特征，并对其预后及其相关危险因素进行分析。方法选择1995年9月至2009年9月内蒙古自治区人民医院明确诊断为AVV内蒙古籍患者123例，血清抗中性粒细胞胞浆抗体（antineutrophil cytoplasmic antibody，ANCA）阳性，根据检测结果将患者分为胞质型（C-ANCA）阳性组和核周型（P-ANCA）阳性组，进行临床、实验室、病理及预后相关因素进行分析。随访终点为死亡或终末期肾衰竭进入规律肾脏替代治疗，平均随访时间5年。结果123例患者中男63例，女60例，男女比例1．05：1，年龄38～82岁，平均年龄（60．0±22．0）岁，50-82岁患者102例（占82．9％）。其中P-ANCA阳性109例，C-ANCA阳性14例。P-ANCA组肾脏、肺脏受累与C-ANCA组相似，消化道、关节、眼损害发生率低于C-ANCA组（P〈0。05）；耳、皮肤、肌肉、神经系统损害2组无统计学差异。123例患者中有62例患者行肾活检，其中细胞性新月体肾炎30例（占48．4％），毛细血管袢坏死12例（占19．4％），细胞伴纤维性新月体形成15例（占24．2％），纤维性新月体伴局灶节段性硬化5例（占8．1％）。对AAV患者进行5年随访，对患者死亡或进入肾脏终末期代替治疗进行相关因素分析：C-ANCA组与P-ANCA组相比，患者死亡与进入终末期替代治疗2组间均无统计学差异（P〉0．05）。对患者的年龄、性别、ANCA类型、发热、肾衰竭、呼吸衰竭、咯血、脏器受累数目、多脏器衰竭、肺感染因素进行COX回归分析：呼吸衰竭、多脏器衰竭为死亡的相关因素（偏回归分数分别为2．087，1．129，均P〈0．05）。对患者起病时实验室数据进行回归分析：血肌酐、红细胞沉降率、血浆白蛋白、血红蛋白与终末终点相关�Objective To investigate the clinicopathological characteristics of antineutrophil cytoplasmic antibody （ANCA）-associated vasculitis （AAV） with renal involvement and other organs in Inner Mongolia People＇s Hospital and to analyze the outcomes and risk factors. Methods Clinical features of 123 cases of AAV hospitalized from September 1995 to September 2009 were reviewed retrospectively. According to the ANCA test results, the patients were divided into cytoplastic ANCA positive group （C-ANCA group） and perinuclear ANCA positive group （P-ANCA group）. The differences in clinicopatbological manifestations, laboratory tests and functional outcomes were observed. The death and renal failure were the end point in the 5 years. Results Of 123 AAV patients, 63 were male, and 60 were female （the male and female ratio was 1.05：1）. The age ranged from 38-82 years old. 82. 9% of them （102 cases） were in the range of 50-82 years old （mean 60 ± 22）. 109 were P- ANCA positive, and 14 were C-ANCA positive. Renal involvement and lung involvement were similar between C-ANCA group and P-ANCA group. The prevalence of respiratory, gastrointestinal, articular and ophthalmic involvements was higher in P-ANCA group than in C-ANCA group （P〈0. 05）. There was no significant difference in otologic, cutaneous, muscular and neural involvements between two groups. Of the 62 cases receiving renal biopsy, crescent nephritis was found in 30 cases, glomerrular segmental necrosis in 12 cases, mesenteria crescent in 15 cases, and fabric crescent with focal segmental sclerosis in 15 cases. There was no significant difference in mortality and renal failure between two groups. Respiratory failure and multiple organ dysfunctions were relative mortality factors in the analysis of age, sex, types of ANCA, fever, renal failure, respiratory and lung infection. There were significant relationships between clinical terminus with serum creatinine, erythrocyte sediment rate, plasma-albumin and hemoglobin. Logistic regression

关 键 词：原发性小血管炎 抗中性粒细胞胞浆抗体 临床病理 危险因素 

分 类 号：R692[医药卫生—泌尿科学] R593.2[医药卫生—外科学]