抗中性粒细胞胞浆抗体相关性小血管炎肾损害17例临床分析

Clinical analysis of anti-neutrophil cytoplasmic antibodies-associated small vessel vasculitis with renal involvement： A report of 17 cases

目的提高对抗中性粒细胞胞浆抗体（ANCA）相关性小血管炎（AAsV）肾损害的认识。方法对2003年6月至2009年12月在我科住院的17例AASV肾损害患者的临床和病理资料进行回顾性分析。结果（1）本组患者以中老年多见，平均年龄（53．3±21．6）岁。（2）以发热、乏力、纳差、体质量下降等全身非特异性表现为首发症状者17例（占100％）；以肾衰竭为首发症状者8例（占47％）；以咳嗽、咳痰、痰中带血或咯血为首发症状者4例（占23．5％）。（3）76．4%患者血沉（ESR）明显增快，64．7%患者C反应蛋白（CRP）升高。（4）17例患者均有不同程度的肾功能损害，其中需要透析者11例（合并肺出血者4例），大量蛋白尿者8例，肉眼血尿者3例。（5）本组11例有活动病变者经治疗后，6例血液透析患者中2例脱离透析，其余4例维持血液透析，5例肾功能好转、蛋白尿及血尿明显减轻、病情稳定；其余6例中，3例未接受冲击诱导治疗，只给予血液透析治疗，3例自动出院。结论对中老年肾病患者，临床上表现为多器官损害，ESR增快，CRP升高，尤其是合并咯血的患者，应早期行抗髓过氧化物酶、抗蛋白酶3、抗肾小球基底膜抗体检查，以明确诊断，提高临床治疗的效果。

Objective To improve the cognition of anti-neutrophil cytoplasmic antibodies-associated small vessel vasculitis （AASV） with renal involvement. Methods The clinical and pathological data of !7 cases of AASV with renal involvement from Jun. 2003 to Dec. 2009 were retrospectively studied. Results （1） The mean age of patients was （53 21 ） years. （2） Fever, anergy, anorexia and weight loss were the initial symptoms in 17 patients （I00 %）. Renal failure was the initial symptom in 8 patients （47%）. Cough, expectoration and hymoptysis were the initial symptoms in 4 patients （23.5%）, （3） Erythrocyte sedimentation rate （ESR） was significantly increased in 76. 4% patients and C-reactive protein （CRP） increased in 64. 7% patients. （4） Seventeen patients had varying degrees of renal function impairment, of which 1 l patients required dialysis （with lung involvement in 4 cases）, 8 patients had a large number of proteinuria and 3 patients had gross hematuria. （5） Eleven patients who had been reactiveness were treated with corticosteroid and cyelophosphamide. Of 6 patients subject to hemodialysis, dialysis was withdrawn in 2 patients, and the remaining 4 received maintenance dialysis. In 5 eases, renal function was improved significantly, proteinuria and hematuria were significantly alleviated,and the disease conditions were stable. Conclusions For the middle-aged kidney disease patients with multiple organ damage, ESR and CRP were significantly higher, particularly in patients with pulmonary hemoptysis anti-MPO, anti-PR3 and anti-GBM measurements are recommended as early as possible in order to identify diagnosis and improve the clinical outcomes.