初始血清C反应蛋白与ANCA相关性血管炎肾损害的临床相关性  

Clinical correlation between incipient C-reactive protein and kidney injury of anti-neutrophil cytoplasmic antibody associated vasculitis

作　　者：张妙妙 徐鹏程[1] 胡水怡 韦丽[1] 贾俊亚[1] 江建青[1] 闫铁昆[1] 林珊[1] Zhang Miaomiao;Xu Pengcheng;Hu Shuiyi;Wei Li;Jia Junya;Jiang Jianqing;Yan Tiekun;Lin Shan.(Department of Nephrology, Tianjin Medical University General Hospital, Tianjin 300052, Chin)

机构地区：[1]天津医科大学总医院肾内科,天津300052

出　　处：《中华肾脏病杂志》2018年第3期167-172,共6页Chinese Journal of Nephrology

基　　金：国家自然科学基金（81200534、81570630、81600554）;天津市应用基础与前沿技术研究计划（15JCQNJC10700）;中国博士后科学基金第56批面上资助（2014M560191）

摘　　要：目的探讨抗中性粒细胞胞浆抗体（anti—neutrophil cytoplasmic antibodv，ANCA）相关性血管炎（ANCA associated vasculitis，AAV）初发时血清C反应蛋白（C．reactive protein，CRP）的临床价值。方法人选138例排除感染的初发AAV患者，按血清CRP水平分为CRP正常、轻度升高及重度升高3组，比较不同CRP水平患者。肾损害的特点。结果77．53％AAV患者就诊时血清CRP升高，CRP重度升高患者伯明翰血管炎活动度评分、血清ANCA水平、白细胞计数及血清补体c3水平最高（均P〈0．05），而血红蛋白及白蛋白水平最低（均P〈0．05），CRP重度升高患者初发症状最多，治疗期间死亡率也最高（均P〈0．05）。肾脏病理显示CRP重度升高患者肾脏局灶型损害比例偏高，而CRP轻度升高患者新月体型比例更高；肉眼血尿比例CRP轻度升高者高于CRP重度升高者；CRP不同水平患者肾脏远期预后无统计学差异。结论AAV初发时CRP水平差异很大，其升高程度能反映患者的炎症水平及病情活动度，但未发现CRP升高程度与肾脏损伤程度相关。Objective To investigate the relationship between the incipient serum C-reactive protein （CRP） and clinieopathologic features in antineutrophil cytoplasmic antibody associated vasculitis （AAV）. Methods Data of 138 consecutive AAV patients were collected. According to their serum CRP levels, patients were divided into group 1 with normal CRP, group 2 with slightly increased CRP and group 3 with severely increased CRP. Clinical features of AAV and histopathologic features of the kidney injury were compared among groups. Results CRP levels increased in 77.53% AAV patients on admission. Patients in the group of severely increased CRP had the highest levels of BVAS, serum C3, serum ANCA titer, leukocyte counts and the lowest levels of hemoglobin and albumin among the 3 groups （all P 〈 0.05）. The mortality during the stage of therapy was highest in patients with severely increased CRP （P 〈 0.05）. The focal kidney damage was more obvious in patients with severely increased CRP. There was no significant difference in renal prognosis among patients with different CRP levels. Conclusion The levels of incipient serum C-reactive protein of AAV vary in different patients and are positively correlated with patients＇ inflammation status as well as the disease activity, but are not correlated with the severity of kidney injury.

关 键 词：抗体 抗中性白细胞胞质 血管炎 C反应蛋白质 炎症 病理分型 

分 类 号：R692[医药卫生—泌尿科学]