不同靶抗原抗中性粒细胞胞浆抗体相关性血管炎胸部CT表现及临床分析  

Chest CT imaging features and clinical characteristics of antineutrophil cytoplasmic antibody-associated vasculitis in different target antigen types

作　　者：孔令彦 李骁 徐一铭 孙志远 KONG Lingyan;LI Xiao;XU Yiming;SUN Zhiyuan(Department of Medical Imaging,Jinling Hospital,Affiliated Hospital of Medical School,Nanjing University,Jiangsu 210002,China)

机构地区：[1]南京大学医学院附属金陵医院(东部战区总医院)放射诊断科,江苏南京210002

出　　处：《影像诊断与介入放射学》2023年第5期323-328,共6页Diagnostic Imaging & Interventional Radiology

基　　金：国家自然科学基金资助项目(82202150)。

摘　　要：目的探讨不同靶抗原类型抗中性粒细胞胞浆抗体(ANCA)相关性血管炎(AAV)患者胸部CT表现及临床特点是否存在差异。方法回顾性分析2012年1月—2022年7月在本院经临床确诊为AAV肺受累患者209例,根据不同特异性靶抗原,分为髓过氧化物酶抗中性粒细浆胞质自身抗体(MPO-ANCA)阳性组和蛋白酶3抗中性粒细浆胞质自身抗体(PR3-ANCA)阳性组,比较两组患者的胸部CT和临床特点。结果MPO-ANCA阳性组188例,PR3-ANCA阳性组21例。临床表现累及肾脏187例(89.47%)、呼吸系统82例(39.23%)、五官系统5例(2.39%)、血液系统5例(2.39%)、消化系统7例(3.35%)、关节8例(3.83%)、皮肤7例(3.35%)。胸部CT表现为结节/肿块57例(27.27%)、磨玻璃密度影186例(89.00%)、实变影68例(32.54%)、网格影96例(45.93%)、纤维条索110例(52.63%)、支气管扩张81例(38.76%)、蜂窝征55例(26.32%)、肺大疱/肺气肿103例(49.28%)、胸腔积液94例(44.98%)、心包积液67例(32.06%)。PR3-ANCA阳性患者出现黑便、关节疼痛、皮肤皮疹临床表现的比例显著高于MPO-ANCA阳性患者(P<0.05),胸部CT表现为结节/肿块征象的比例显著高于MPO-ANCA阳性患者(P<0.05)。而MPO-ANCA阳性患者胸部CT表现为磨玻璃密度影、网格影、蜂窝征、支气管扩张及肺大疱、肺气肿的比例显著高于PR3-ANCA阳性患者(P<0.05)。结论不同靶抗原类型AAV的胸部CT表现及临床特点存在差异,把握影像及临床要点有利于疾病早期诊断。Objective To investigate the CT features and clinical characteristics of anti-neutrophil cytoplasmic antibody(ANCA)-associated vasculitis(AAV)in different target antigen types.Methods 209 patients with clinically confirmed pulmonary AAV in our hospital between January 2012 and July 2022 were divided into 188 myeloperoxidase-ANCA(MPO-ANCA)-positive and 21 proteinase 3-ANCA(PR3-ANCA)-positive groups according to the different specificity of the target antigens.The chest CT features and clinical characteristics of the two groups were retrospectively compared.Results AAV involved the kidneys(187),respiratory tract(82),joints(8),digestive system(7),skin(7),hematological system(5),paranasal sinuses,ears,and eyes(5).The CT appearance included ground glass opacities(186),fibrous striae(110),pulmonary maculopathy/emphysema(103),reticular opacities(96),pleural effusion(94),bronchiectasis(81),consolidations(68),pericardial effusion(67),nodule/mass(57),and honeycombing(55).The proportion of PR3-ANCA-positive patients present with hematochezia,arthralgia,and skin rash,and proportion of nodules/masses on chest CT were both significantly higher than that of MPO-ANCA-positive patients(P<0.05).MPO-ANCA-positive patients had significantly higher rates of ground glass opacities,reticular opacities,honeycombing,bronchiectasis,and pulmonary maculopathy/emphysema than that of PR3-ANCA-positive patients(P<0.05).Conclusion Chest CT appearance and clinical characteristics differ between target antigen types of AAV.

关 键 词：抗中性粒细胞胞浆抗体相关性血管炎 肺部间质性病变 肉芽肿性病变 体层摄影术 X线计算机 临床特点 

分 类 号：R543[医药卫生—心血管疾病] R563[医药卫生—内科学] R814.42[医药卫生—临床医学]