老年抗中性粒细胞胞浆抗体相关性小血管炎肺部损害29例临床分析

Clinical analysis of ANCA associated vasculitis with pulmonary damage in 29 elderly cases

目的探讨老年抗中性粒细胞胞浆抗体(ANCA)相关性小血管炎肺脏损害的临床特征。方法分析2002年9月至2011年9月住院的29例60岁以上的ANCA相关性小血管炎肺损害患者的临床资料。结果 29例ANCA相关性小血管炎肺脏损害患者。常见症状有咳嗽、咯痰(19/29,65.5%);呼吸困难(14/29,48.2%);咯血(7/29,24.1%)和发热(16/29,55.1%)。所有患者ANCA均阳性,其中髓过氧化物酶(MPO)-ANCA阳性率89.7%(26/29),蛋白酶3(PR3)-ANCA阳性率10.3%(3/29)。胸部影像学表现为肺间质纤维化16例,磨玻璃影者6例,浸润影5例,结节性病变1例,胸腔积液1例。24例(82.8%)合并肾脏受累表现。经激素和免疫抑制剂治疗后短期预后较好,9例(31%)于初诊及随访期间因肺部感染呼吸衰竭等死亡。结论老年原发性ANCA相关性小血管炎患者常有肺脏损害,其临床表现无特异性,肺间质纤维化、磨玻璃影为常见影像学表现,且多合并肾脏受累。

Objective To retrospectively analyze the clinical features of anti-neutrophil cytoplasmic antibody（ANCA） associated vasculitis with pulmonary damage in elderly patients in an attempt to improve diagnosis and treatment of this disease.Methods We retrospectively investigated the clinical data of 29 elderly patients（≥60yr） hospitalized with ANCA from September 2002 to September 2011.Results The average age of 29 elderly patients was 70.8（62~86） years,and male 17,female 12.The common symptoms of vasculitis were cough and expectoration（19/29,65.5%）,dyspnea（14/29,48.2%）,hemoptysis（7/29,24.1%）,and fever（16/29,55.1%）.The prevalence of positive MPO-ANCA antibodies in patients was 89.7%（26/29）.The prevalence of positive PR3-ANCA antibodies was 10.3%（3/29）.Radiographic manifestations included interstitial pulmonary fibrosis（16/29）,ground glass attenuation（6/29）,infiltrates（5/29）,nodule lesions（1/29） and pleural effusion（1/29）.24（82.8%） patients had renal damage.Although the short term prognosis was well in patients with pulmonary involvement treated with systemic corticosteroids and cyclophosphamide,9（31%）patients died of respiratory failure or severe infections within the induction therapy period or during follow-up.Conclusion Pulmonary involvement in elderly patients with ANCA associated vasculitis was common.The clinical manifestations of pulmonary involvement were nonspecific,radiographic manifestations included interstitial pulmonary fibrosis,ground glass attenuation,and renal involvement was common.Early diagnosis and appropriate treatment may improve the prognosis.