类风湿关节炎合并ANCA相关性血管炎5例临床特点分析  

Clinical features of 5 patients with rheumatoid arthritis complicated with ANCA-associated vasculitis

作　　者：汪海玥 谷慧敏 杨云娇[1] 李菁 WANG Hai-yue;GU Hui-min;YANG Yun-jiao;LI Jing(Dept.of Rheumatology and Clinical Immunology,Peking Union Medical College Hospital,CAMS ＆ PUMC,Key Laboratory of Rheumatology and Clinical Immunology,Ministry of Education,Beijing 100032;Dept.of Rheumatology and Immunology,Yantai Hospital of Traditional Chinese Medicine,Yantai 264013;Dept.of Rheumatology and Immunology,the Second Affiliated Hospital of Henan University of Traditional Chinese Medicine,Zhengzhou 450002,China)

机构地区：[1]中国医学科学院北京协和医学院北京协和医院风湿免疫科教育部风湿免疫病学重点实验室,北京100032 [2]烟台市中医医院风湿免疫科,山东烟台264013 [3]河南中医药大学第二附属医院风湿免疫科,河南郑州450002

出　　处：《基础医学与临床》2018年第10期1448-1451,共4页Basic and Clinical Medicine

基　　金：国家自然科学基金(81401333)

摘　　要：目的分析类风湿关节炎(RA)合并ANCA相关性血管炎(AAV)这一少见临床表现的特点。方法回顾性分析北京协和医院2003年1月至2015年7月收治的5例RA合并AAV患者的临床特点、实验室检查、影像学资料及肾脏穿刺活检结果。结果 5例患者均为显微镜下多血管炎(MPA),女性3例,男性2例,MPA发病均晚于RA的诊断,除肾脏(100%)受累外,较易受累脏器为肺(60%)、耳鼻喉(20%)和眼(20%),易出现体质量下降(40%)。结论RA合并AAV是一种极为少见的临床表现,二者可能有共患易感性,在RA患者中出现肾损害需警惕合并AAV的可能,特别是不合并糖尿病、高血压及可疑药物应用史的患者。Objective To analyze the characteristics of rare clinical manifestation of rheumatoid arthritis（RA） with ANCA-associated vasculitis（AAV）. Methods Five hospitalized patients from Peking Union Medical College Hospital from January 2003 to July 2015 were diagnosed as RA with AAV. The medical records were retrospectively analyzed for clinical manifestations, laboratory examination, imaging findings, and pathological results of renal needle biopsy. Results 5 patients （3 females and 2 males） were diagnosed as microscopic polyangiitis （MPA）, and all previously diagnosed with RA. All patients had renal abnormalities （100%）, and pulmonary （60%）, ENT （20%） and eye （20%） involvement was found. Weight loss was found in 2 patients. Conclusions RA with AAV is a rare clinical manifestation, but these two diseases may have a mutual genetic predisposition. Complication with AAV should be taken into considerations while new-onset renal abnormalities were found in RA patients without hypertension, diabetes, or related medication history.

关 键 词：ANCA相关性血管炎 类风湿关节炎 临床特点 

分 类 号：R593.2[医药卫生—内科学]