人类免疫缺陷病毒感染合并抗中性粒细胞胞质抗体相关肾炎1例并文献复习  

Anti‐neutrophil cytoplasmic antibodies‐associated glomerulonephritis in human immunodeficiency virus infection:a case report and literature review

作　　者：林媚[1] 张海红[1] 邹育明 梁琼仙[1] 劳惠媚 吴秋仪 谭晓军[1] Lin Mei;Zhang Haihong;Zou Yuming;Liang Qiongxian;Lao Huimei;Wu Qiuyi;Tang Xiaojun(Department of Nephrology,Kaiping Central Hospital of Guangdong Province,Jiangmen 529300,China)

机构地区：[1]广东开平市中心医院肾内科,江门529300

出　　处：《中华肾脏病杂志》2023年第5期383-385,共3页Chinese Journal of Nephrology

摘　　要：抗中性粒细胞胞质抗体(anti-neutrophil cytoplasmic antibodies,ANCA)相关血管炎(ANCA-associated vasculitis,AAV)是由ANCA介导的以小血管壁炎性反应和纤维素坏死为特征的一类系统性疾病,AAV导致的肾脏损伤被称为ANCA相关肾炎(ANCA-associated glomerulonephritis,AAGN)。该文报道1例人类免疫缺陷病毒(human immunodeficiency virus,HIV)感染合并AAGN的病例。患者为老年男性,临床表现为血尿、尿毒症,肾脏病理检查示AAV肾损伤。该病例为国内首次报道,同时复习相关文献,究竟两种疾病是重叠还是HIV相关肾炎的特殊病理类型,目前尚无定论。我们认为AAV有可能发生于HIV感染患者中,临床医师不应忽视HIV感染者出现ANCA阳性的现象,需加强对此类患者的随访。临床及肾脏病理检查为诊断HIV感染合并AAV的主要方法。此类患者存在免疫缺陷,机会性感染风险高,如何进行免疫抑制治疗及疗效评估,目前尚无明确的指南指引,需要制订个体化的治疗策略,使患者获得最佳疗效。Anti neutrophil cytoplasmic antibodies(ANCA)-associated vasculitis(AAV)is a systemic disease characterized by small vessel wall inflammation and cellulose necrosis mediated by ANCA.Renal injury caused by AAV is called ANCA-associated glomerulonephritis(AAGN).The paper reported a case of AAV with renal damage combined with human immunodeficiency virus(HIV)infection.The patient was an elderly male with clinical manifestations of hematuria and uremia.Renal pathological examination showed AAV and renal injury.This case is the first report in China while reviewing the relevant literature,and it is still inconclusive whether this is an overlap of the two diseases or a specific pathological type of HIV-associated nephritis.We believe that AAV has the potential to occur in HIV-infected patients,so clinicians should not ignore the phenomenon of ANCA positivity in HIV-infected patients,and the follow-up of such patients needs to be enhanced.Clinical and renal pathological examinations are the main methods to diagnose HIV infection with AAV.At the same time,there are no clear guideline guidelines on how to administer immunosuppressive therapy for such patients who have immunodeficiency and are at higher risk of opportunistic infections,and in whom to make the best possible outcomes.

关 键 词：HIV感染 抗中性粒细胞胞浆抗体相关性血管炎 肾小球肾炎 

分 类 号：R692.3[医药卫生—泌尿科学] R512.91[医药卫生—外科学]