抗中性粒细胞胞浆抗体相关性血管炎的胸部CT及临床特征分析  

Chest CT and clinical features of antineutrophil cytoplasmic antibody-associated vasculitis

作　　者：杨柳 陈佳 孙雅娟 陈娇 谭明超 龚明福 Yang Liu;Chen Jia;Sun Yajuan;Chen Jiao;Tan Mingchao;Gong Mingfu(Department of Radiology,Xinqiao Hospital,Army Military Medical University,Chongqing 400037,China)

机构地区：[1]陆军(第三)军医大学第二附属医院放射科,重庆400037

出　　处：《中华肺部疾病杂志（电子版）》2024年第5期744-749,共6页Chinese Journal of Lung Diseases(Electronic Edition)

基　　金：重庆市中青年医学高端人才项目。

摘　　要：目的分析不同靶抗原类型抗中性粒细胞胞浆抗体(antineutrophil cytoplasmic antibodies,ANCA)相关性血管炎(ANCA-associated vasculitis,AAV)的胸部CT及临床特征。方法收集2015年1月至2023年12月就诊于陆军军医大学第二附属医院的355例AAV患者的临床及胸部CT影像资料,根据血清中存在不同特异性靶抗原,分为髓过氧化物酶(myeloperoxidase,MPO)抗中性粒细胞胞浆抗体MPO-ANCA和蛋白酶3(proteinase 3,PR3)抗中性粒细胞胞浆抗体PR3-ANCA两型,其中MPO-ANCA阳性311例,PR3-ANCA阳性44例,比较两个亚型年龄、受累器官、影像学等指标。结果311例MPOANCA阳性患者平均年龄(61.26±13.29)岁高于44例PR3-ANCA阳性患者平均年龄(47.75±15.07)岁(P<0.001)。AAV患者主要受累器官为肾脏和肺部,其中累及肾脏247例(69.58%),累及肺部125例(35.21%)。MPO-ANCA阳性患者肾脏受累225例(72.34%)高于PR3-ANCA阳性患者22例(50.00%)(P<0.05)。AAV患者肺部受累的影像表现为,磨玻璃密度影172例(48.45%),间质性改变162例(45.63%),结节或肿块135例(38.03%),肺气肿或肺大泡96例(9.58%)。其中MPO-ANCA阳性患者表现为肺间质性改变151例(48.55%)、肺气肿或肺大疱90例(28.94%)高于PR3-ANCA阳性患者11例(25.00%)、6例(13.64%)(P<0.005)。MPO-ANCA阳性患者胸部CT表现为双肺结节或肿块105例(33.76%)低于PR3-ANCA阳性患者30例(68.18%)(P<0.005)。结论AAV临床表现以肾脏和肺部受累最常见,胸部CT影像学表现主要为磨玻璃密度影、间质性改变、结节或肿块。不同靶抗原AAV胸部CT影像特征部分存在差异,对于辅助早期诊断具有临床意义。Objective To analyze the chest CT and clinical characteristics of antineutrophil cytoplasmic antibodies(ANCA)-associated vasculitis(AAV)with different target antigen types.Methods A retrospective analysis was conducted on the clinical and chest CT imaging data of 355 AAV patients who were treated at the Second Affiliated Hospital of Army Medical University from January 2015 to December 2023.Based on the different specific target antigens present in the serum,the patients were classified into two groups:myeloperoxidase(MPO)antineutrophil cytoplasmic antibodies(MPO-ANCA)and proteinase 3(PR3)antineutrophil cytoplasmic antibodies(PR3-ANCA).Among them,311 patients were positive for MPO-ANCA,and 44 patients were positive for PR3-ANCA.The two subtypes were compared in terms of age,affected organs,and different imaging manifestations.Results Among the 355 AAV patients,the mean age of 311 cases MPOANCA-positive patients was(61.26±13.29)years,while the mean age of 44 cases PR3-ANCA-positive patients was(47.75±15.07)years.The mean age of MPO-ANCA-positive patients was significantly higher than that of PR3-ANCA-positive patients(P<0.001).The main affected organs in AAV patients were the kidneys and lungs,with 247 cases(69.58%)involving the kidneys and 125 cases(35.21%)involving the lungs.The proportion of renal involvement in MPO-ANCA-positive patients 225 cases(72.34%)was also significantly higher than that in PR3-ANCA-positive patients 22 cases(50.00%)(P<0.05).The imaging manifestations of lung involvement in AAV patients were diverse,with 172 cases(48.45%)showing ground-glass opacity,162 cases(45.63%)showing interstitial changes,135 cases(38.03%)showing nodules or masses,and 96 cases(9.58%)showing emphysema and bullae.Among them,MPO-ANCA-positive patients had a higher proportion of interstitial lung changes(48.55%vs.25.00%,P<0.05)and emphysema and bullae(28.94%vs.13.64%,P<0.05)compared with PR3-ANCA-positive patients.In contrast,PR3-ANCA-positive patients had a higher proportion of bilateral lung nodules or masses on ch

关 键 词：抗中性粒细胞胞浆抗体相关性血管炎 肺部损伤 肾脏损伤 胸部影像表现 临床特征 

分 类 号：R563[医药卫生—呼吸系统]