老年嗜酸性肉芽肿性多血管炎患者的临床分析  

Clinical analysis of eosinophilic granulomatosis with polyangiitis in elderly patients

作　　者：张隽[1] 李杰[1] 王晶[1] 华琳[2] 张黎明[1] Zhang Jun;Li Jie;Wang Jing;Hua Lin;Zhang Liming(Department of Respiratory and Critical Care Medicine,Beijing Institute of Respiratory Medicine and Beijing ChaoYang Hospital,Capital Medical University,Beijing 100043,China;Department of Mathematics School of Biomedical Engineering,Capital Medical University,Beijing 100069,China)

机构地区：[1]首都医科大学附属北京朝阳医院-北京市呼吸病研究所呼吸与危重症医学科,北京100043 [2]首都医科大学生物医学工程学院智能医学工程学学系,北京100069

出　　处：《首都医科大学学报》2024年第3期515-523,共9页Journal of Capital Medical University

摘　　要：目的分析老年嗜酸性肉芽肿性多血管炎(eosinophilic granulomatosis with polyangiitis,EGPA)患者的临床特征。方法回顾性分析2007年2月至2022年2月首都医科大学附属北京朝阳医院确诊的EGPA患者的临床资料,根据年龄分为老年组(年龄≥60岁)和非老年组(年龄<60岁),比较两组患者临床特征的差异并随访预后。结果共纳入101例EGPA患者,其中老年组42例(41.6%),非老年组59例(58.4%)。老年组与非老年组比较,合并高血压病(40.5%vs 16.9%,P=0.008)、血嗜酸性粒细胞>10%(90.5%vs 72.9%,P=0.029)及估算肾小球滤过率(estimated glomerular filtration rate,eGFR)降低[eGFR<80 mL·min^(-1)·(1.73 m^(2))^(-1)](61.9%vs 16.9%,P<0.001)的患者比例更高,老年组红细胞沉降率(erythrocyte sedimentation rate,ESR)[20(10,56.25)mm/h vs 12(5,32.25)mm/h,P=0.028]及肺功能指标残气量/肺总量(residual volume/total lung capacity,RV/TLC)[(48.84±11.43)%vs(41.92±9.06)%,P=0.009]更高。老年组与非老年组相比,心脏受累(73.8%vs 32.2%,P<0.001)、中枢神经系统受累(23.8%vs 5.1%,P=0.006)、周围神经系统病变(83.3%vs 64.4%,P=0.036)、肾脏受累(69.0%vs 47.5%,P=0.031)及五因子评分(five-factor score,FFS)≥2分(61.9%vs 15.3%,P<0.001)的发生率均更高。随访中位时间41(19,59)个月,6例患者死亡,老年组病死率高于非老年组(13.9%vs 1.92%,P=0.032)。结论老年EGPA患者合并高血压病、血嗜酸性粒细胞>10%、eGFR降低、脏器受累及FFS≥2分的患者比例更高,ESR、RV/TLC及病死率更高。临床医生应加强对老年EGPA患者疾病特征的认识,以提高诊断和治疗水平。Objective To analyze the clinical features of eosinophilic granulomatosis with polyangiitis(EGPA)in elderly patients.Methods The clinical data of patients diagnosed with EGPA at Beijing Chaoyang Hospital,Capital Medical University from February 2007 to February 2022 were retrospectively analyzed.The patients were divided into the elderly group(age≥60 years old at diagnosis)and the non-elderly group(age<60 years old at diagnosis).Clinical features between the 2 groups were compared and the prognosis was followed up.Results A total of 101 patients were included,with 42 cases(41.6%)in the elderly group and 59 cases(58.4%)in the non-elderly group.Compared with the non-elderly group,the elderly group had significantly higher proportion of hypertension(40.5%vs 16.9%,P=0.008),blood eosinophils>10%(90.5%vs 72.9%,P=0.029)and estimated glomerular filtration rate(eGFR)<80 mL·min^(-1)·(1.73 m^(2))^(-1)(61.9%vs 16.9%,P<0.001),and also had significantly higher erythrocyte sedimentation rate(ESR)[20(10,56.25)vs 12(5,32.25)mm/h,P=0.028]and lung functional parameter of residual volume/total lung capacity(RV/TLC)[(48.84±11.43)vs(41.92±9.06)%,P=0.009].Compared with the non-elderly group,the incidence of cardiac involvement(73.8%vs 32.2%,P<0.001),central nervous system involvement(23.8%vs 5.1%,P=0.006),peripheral nervous system lesions(83.3%vs 64.4%,P=0.036),kidney involvement(69.0%vs 47.5%,P=0.031)and five-factor scores(FFS)≥2(61.9%vs 15.3%,P<0.001)were all significantly higher in the elderly group.The median follow-up time was 41(19,59)months,6 patients died and the mortality rate in the elderly group was higher than that in the non-elderly group(13.9%vs 1.92%,P=0.032).Conclusion The elderly EGPA patients have higher proportion of hypertension,blood eosinophils>10%and decreased eGFR,the organs involved and FFS≥2,higher ESR,RV/TLC and mortality rate.Clinicians should reinforce their understanding of characteristics of EGPA in elderly patients so as to improve the diagnostic and treatment proficiency.

关 键 词：嗜酸性肉芽肿性多血管炎 老年患者 临床特征 

分 类 号：R543[医药卫生—心血管疾病]