结节性多动脉炎肾脏损害的临床及病理研究

Clinical and pathological studies of renaldamage in polyarteritis nodosa (PAN)

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.