基层医院ANCA相关性小血管炎肾损伤患者的诊治现状及误诊分析  

作　　者：王芝芩 费鑫法 余戈平 曹占兴 徐晓 

机构地区：[1]浙江省桐庐县第一人民医院,311500

出　　处：《浙江临床医学》2019年第8期1113-1115,共3页Zhejiang Clinical Medical Journal

摘　　要：目的观察基层医院原发性抗中性粒细胞胞浆抗体(ANCA)相关性小血管炎(AASV)肾损伤患者的临床诊治现状,分析其病例特点及误诊情况.方法回顾性分析本院32例患者的临床资料,统计分析总结其临床特征、诊治预后及误诊情况.结果 32例患者平均发病年龄(66.83±13.88)岁,临床上除肾脏受累外,以肺脏受累最多见,其次为消化道.肾脏以红细胞尿(87.5%)、蛋白尿(81.3%)、血肌酐升高(78.1%)为主要表现,肾脏病理以寡免疫沉积性、新月体、襻坏死为主要特点.肺脏临床主要表现为咳嗽、咯血、胸闷气促,胸部CT 表现以间质性肺病(53.57%)为主.消化道症状以恶心呕吐、腹胀腹痛、便血为主.发热(37.5%)、贫血(81.3%)亦多见,其他表现包括乏力、纳差、消瘦、手足麻木、关节肌肉酸痛、皮肤紫癜、眼干、耳鸣、鼻息肉等.本资料显示该疾病的误诊率高达78.1%,误诊原因多样化.32例患者经激素和免疫抑制剂等综合治疗后病情稳定,9例(28.1%)完全缓解,7例(21.9%)显著缓解,10例(31.3%)部分缓解,总缓解率为81.3%,6例(18.7%)无效,其中2例因严重肺部感染、呼吸衰竭死亡.结论 AASV临床表现复杂多样,在基层医院首诊误诊率较高,临床需提高警惕.肾脏和肺脏是其最易受累器官,其次消化道受累亦多见.早期诊断,及时、规范化、个体化的激素和免疫抑制剂治疗是改善患者预后的关键,治疗期间合并肺部间质性病变时肺部感染发生率高,是其死亡的主要原因.Objective To observe the status of clinical diagnosis and treatment of primary ANCA-related small vasculitis(AASV)renal injury in primary hospitals and analyze its case characteristics and misdiagnosis. Methods The clinical data of 32 cases in our hospital were retrospectively analyzed. Results The age of onset of 32 patients was(66.83±13.88)years. In addition to renal involvement,lung involvement was the most common, followed by digestive tract. The kidneys were mainly characterized by erythrocyte urine(87.5%),proteinuria(81.3%),and blood creatinine (78.1%). The kidney pathology was mainly characterized by oligoimmune deposition,crescent body,and necrosis. The main clinical manifestations of lungs were cough,hemoptysis,and chest shortness of breath,and chest CT manifestations were mainly interstitial lung disease(53.57%). Gastrointestinal symptoms were mainly nausea and vomiting,abdominal distension and abdominal pain,and blood. Fever(37.5%)and anemia(81.3%) were also common. Other manifestations including fatigue,Nacha,wasting,numbness of hands and feet,joint muscle soreness,skin Purpura,dry eyes,tinnitus,nasal polyps,etc.This study showed that the rate of misdiagnosis of the disease was as high as 78.1%,and the causes of misdiagnosis were diversified. 32 patients were more stable after combined treatment with hormones and immunosuppressants,9 cases(28.1%)were completely relieved, 7 cases(21.9%)were significantly relieved,10 cases(31.3%) were partially relieved,the total remission rate was 81.3%,and 6 cases(18.7%) were ineffective. Two of them died of severe lung infection and respiratory failure. Conclusion AASV clinical manifestations are complex and diverse, and the rate of misdiagnosis in the first diagnosis in basic hospitals is high,and clinical vigilance is needed. The kidneys and lungs are the most vulnerable organs,and secondary digestive tract involvement is also common. Early diagnosis,timely,standardized,individualized treatment of hormones and immunosuppressants are the key to improving the progno

关 键 词：ANCA 小血管炎 肾损伤 肺间质病变 误诊 

分 类 号：R543[医药卫生—心血管疾病]