摘要
本文总结了18例经临床和病理确诊的结节性多动脉炎(PAN),分析其临床及清理特征,发现:①微型PAN占绝大多数,肾小球和肾小管-间质损害严重,②肾外以贫血、心脏、消化道、盯脏、神经系统损害多见,高血压发生率较高;③绝大部分的肾脏有免疫复合物沉积,抗中性粒细胞胞浆抗体(ANCA)阳性率低(23%)。对PAN的早期诊断及治疗选择有赖于早期肾活检,ANCA只能作为辅助诊断工具,阴性并不能否定PAN诊断。同时本文资料亦表明,PAN的肾脏损害以免疫复合物介导为主,部分与ANCA相关。
arly diagnosis for the renal
involve-ment in PAN was critical for its prognosis.To find early diagnostic clues, 18 PAN
withrenal damage were investigated in thisstudy. Renal biopsy was perforrned on allpatients.
Renal tissues were examined bylight microscopy and immune-enzyme exam-ination. 72%
cases presented with renalmanifestations (nephritic syndrom ,haemoturia) at onset. Clinical
charactericswere as follows :hypertension (77. 8%) ,se-vere anemia (94. 4%), elevated SCr
(mean380μmol/L ) and kidney enlargement( 100%) , nephroticsyndrome ( 55. 6%).Extrarenal
involvement: heart ( 55. 6%),pericarditis (27. 8%) , gastrointestinal ( 38.9%), liver (33. 8%) ,
nervous system andjoint ( 27.8%). Serum cryoglobin was high(mean 99± 94) ,ANCA positivity
by iF was23. 2% ,wherese positive MPO- ANCA was33. 3%. In renal biopsies,fibrinoid
necrosisin glomeruli and interstial vasculi werefound in 78% and 80. 9% respectively, cre-sant
formation in 72. 2% kidneys. Severetubular-interstitial lesions (acute andchronic) were prescent
in almost all pa-tients. In conclusion: patients with renalmenifestations, coexisted with
hyperten-tion , anemia and other organ darnage, espe-cially with progressive deteriation of
renalfunction should be highly suspected asPAN. Renal biopsy was critical for the ear-ly
diagnosis and ANCA negative could notexclude PAN.
出处
《肾脏病与透析肾移植杂志》
CAS
CSCD
1994年第6期466-469,共4页
Chinese Journal of Nephrology,Dialysis & Transplantation