以发热起病的抗肾小球基底膜病临床特点和预后分析

Clinical characteristics and prognosis analysis of anti-glomerular basement membrane disease starting with fever

目的 探讨以发热为首发症状的抗肾小球基底膜(GBM)病患者的临床及预后特点。方法 回顾性分析2012年2月至2020年9月东部战区总医院国家肾脏疾病临床医学研究中心重症监护室收治的抗GBM病患者54例,按首发症状是否发热分为发热组(24例)和非发热组(30例)。分析发热病因并比较两组临床特点。结果 发热组患者13例为低热,7例中度热,4例高热。21例(87.50%)患者发热考虑与感染有关,其中19例肺部感染,2例尿路感染,有3例未发现明确感染。发热组发病至确诊时间明显长于非发热组(P<0.05)。发热组患者胸部CT异常、合并肺出血比例,无尿和少尿发生率显著高于非发热组患者(P<0.05)。发热组患者抗GBM抗体滴度、C反应蛋白和降钙素原水平、确诊时血清肌酐水平显著高于非发热组(P<0.05)。生存分析结果显示,发热组患者进展至终末期肾病比例明显高于非发热组患者(log rank test χ^(2)=9.660,P=0.002)。结论 以发热起病的抗GBM病多数与感染有关,常导致确诊与治疗时间延误,病情进展更快,预后较差,需引起临床医生重视。

Objective To investigate the clinical and prognostic characteristics of patients with anti-glomerular basement membrane(GBM)disease with fever as the first symptom. Method A retrospective analysis was made in 54 patients with anti-GBM disease treated in department of intensive care unit, National Clinical Research Center of Kidney Diseases,Jinling Hospital from February 2012 to September 2020. The patients were divided into fever group(24 cases)and nonfever group(30 cases)according to whether the first symptom was fever. Analyze the cause of fever and compare the clinical characteristics between the two groups. Result In the fever group,13 patients had a low fever,7 had a moderate fever,and 4 had a high fever. Fever was considered to be related to infection in 21 cases(87.50%),including 19 cases of pulmonary infection and 2 cases of urinary tract infection,while 3 cases had no definite infection. The time from onset to confirmed diagnosis in the fever group was significantly longer than that in the non-fever group(P<0.05). The rate of abnormal chest CT,the proportion of pulmonary hemorrhage,the incidence of anuria and oliguria in the fever group were significantly higher than those in the non-fever group(P<0.05). Anti-GBM antibody titers,C-reactive protein and procalcitonin levels,and serum creatinine levels at the time of confirmed diagnosis were significantly higher than those in the non-fever group(P<0.05). The results of survival analysis showed that the proportion of patients progressing to endstage renal disease in the fever group was significantly higher than that in the non-fever group(log rank test χ^(2)=9.660,P=0.002). Conclusion Most of the anti-GBM diseases that start with fever are related to infection,often leading to delay in confirmed diagnosis and treatment,faster disease progression and relatively poor prognosis,which should draw the attention of clinic doctors.