显微镜下多血管炎临床特点及预后因素  

Clinical characteristics and prognostic factors of microscopic polyangiitis

作　　者：纪云龙 李婷婷[1] 姜新 刘斌[1] JI Yun-long;LI Ting-ting;JIANG Xi;LIU Bin(Department of Rheumatology and Immunology,Affiliated Hospital of Qingdao University,Qingdao 266003,Shandong,China;Department of Medicine,Qingdao University,Qingdao 266071,Shandong,China;Qingdao Hospital Affiliated to Shandong First Medical University,Qingdao 266109,Shandong,China;Department of Gastroenterology,Affiliated hospital of Qingdao University,Qingdao 266003,Shandong,China)

机构地区：[1]青岛大学附属医院风湿免疫科,山东青岛266003 [2]青岛大学医学部,山东青岛266071 [3]山东第一医科大学附属青岛医院风湿肾病科,山东青岛266109 [4]青岛大学附属医院消化内科,山东青岛266003

出　　处：《中华临床免疫和变态反应杂志》2020年第5期441-446,共6页Chinese Journal of Allergy & Clinical Immunology

基　　金：国家自然科学基金(81671600);山东省自然科学基金(ZR2016HM13)。

摘　　要：目的分析显微镜下多血管炎(microscopic polyangitis,MPA)的临床特点及预后因素。方法收集青岛大学附属医院2013年1月至2019年1月诊断为MPA且完成随访的90例患者资料,分析其临床特点。根据临床结局,分为完全缓解组(complete remission,CR)、部分缓解组(partial remission,PR)、未缓解组(non-remission,NR),分析其血清学指标之间的差异。结果MPA患者男女比例为1∶1.14,平均年龄(66.0±12.7)岁,年龄≥65岁者占60%,中位确诊时间50 d。MPA临床表现复杂多样,肾脏受累占88.9%(80例),呼吸道受累占51.1%(46例),其中16例发生咯血等肺泡出血表现,消化道受累占27.0%(30例)。CR组的白蛋白(ALB)明显高于PR组和NR组,血沉(ESR)明显低于PR组和NR组;CR组唾液酸(sialic acid,SA)、尿素氮(BUN)、肌酐(CREA)、C反应蛋白(CRP)、BVAS评分明显低于NR组,CR组血红蛋白(HGB)明显高于NR组。PR组BUN、CREA、CRP、ESR、BVAS评分明显低于NR组,ALB高于NR组,差异均具有统计学意义(P<0.05)。结论MPA可累及多系统,且病变程度不一,ALB、ESR、CRP、SA、HGB、BUN、CREA、BVAS评分可作为患者预后的评估指标。Objective To analyze the clinical characteristics and prognostic factors of microscopic polyangiitis(MPA).Methods The data of 90 patients with MPA diagnosed and followed up in the affiliated Hospital of Qingdao University from January 2013 to January 2019 were collected and their clinical features were analyzed.According to the clinical outcome,the patients were divided into complete remission(CR)group,partial remission(PR)group,and non-remission(NR)group.The differences of serological indexes were analyzed.Results The male to female ratio of MPA patients was 1∶1.14 and the average age was(66.0±12.7)years.Patients aged over 65 accounted for 60%and the median diagnosis time was 50 days.The clinical manifestations of MPA were complex and varied,with kidney involvement accounting for 88.9%(80 cases)and respiratory involvement accounting for 51.1%(46 cases).Sixteen cases were complicated with alveolar hemorrhageand.Digestive involvement accounted for 27.0%(30 cases).Albumin(ALB)levels in CR group were significantly higher than those in PR group and NR group,ESR was significantly lower than that in PR group and NR group.Sialicacid(SA),blood urea nitrogen(BUN),creatinine(CREA),C reactive protein(CRP),and BVAS scores in CR group were significantly lower than those in NR group,hemoglobin in CR group was significantly higher than that in NR group.BUN,CREA,CRP,ESR,and BVAS scores in PR group were significantly lower than those in NR group,ALB was higher than that in NR group.The differences were statistically significant(P<0.05).Conclusion MPA can involve multiple systems with different degrees of lesion.ALB,ESR,CRP,SA,HGB,BUN,CREA,and BVAS scores can be used as indexes to evaluate the prognosis of patients.

关 键 词：显微镜下多血管炎 临床特点 预后因素 

分 类 号：R73[医药卫生—肿瘤]