原发ANCA相关性小血管炎发生慢性肾功能衰竭的临床分析

Clinical study on primary ANCA associated vasculitis induced chronic renal failure

目的探讨原发ANCA相关性小血管炎发生慢性肾功能衰竭的危险因素。方法 74例确诊原发ANCA相关小血管炎患者,跟踪随访至少1年,以是否进入慢性肾功能衰竭分为肾功能正常组(对照组)和慢性肾功能衰竭组(观察组),对比分析两组患者的临床资料,探寻肾功能预后不良的相关危险因素。结果 74例患者中1年内发生慢性肾功能衰竭43例(58.1%),与肾功能正常组患者相比:(1)贫血、消化道症状的发生率在慢性肾功能衰竭组中较高(P<0.05);(2)尿蛋白水平、肾穿时的血清尿素氮水平、血清肌酐水平、血清尿酸水平在慢性肾功能衰竭组是增高的(P<0.05);(3)两组患者收缩压、舒张压、血红蛋白、红细胞计数、肾脏病理慢性评分差异有统计学意义(P<0.05),均在慢性肾功能衰竭组中增高。结论 ANCA相关小血管炎发生慢性肾功能衰竭可能相关的危险因素:消化道症状,尿蛋白水平,血尿素氮、肌酐、尿酸水平,高血压,贫血和肾脏慢性病理改变。

Objective To investigate the risk factors of primary ANCA associated vasculitis （AAV） induced chronic renal failure （CRF）. Methods Seventy - four patients with confirmed primary ANCA associated vasculitis were followed up for one year, and were assigned into chronic renal failure group and normal renal function group according to renal function after followed - up. Clinical data were analysis of the risk faetors associated with poor renal prognosis. Resuits （1） The prevalence of chronic renal failure was 58. 1% , while there were significantly higher rates of anemia and gastrointestinal symptoms in chronic renal failure group （ P 〈 0. 05 ）. （2） Significantly higher urinary protein excretion, serum urea nitrogen, serum creatinine and serum uric were observed in CRF group （ P 〈 0. 05 ）. （3） Significant increase of in blood pressure, hemoglobin, red blood cell count and chronic score of renal were revealed in CRF group （ P 〈 0. 05 ）. Conclusion Gastrointestinal symptoms, urinary protein excretion, renal dysfunction, hypertension, anemia and chronic renal pathological changes are risk factors of AAV induced CRF.