显微镜下多血管炎肺损害20例临床分析

Clinical analysis of microscopic polyangiitis with pulmonary involvement in 20 cases

目的 :研究显微镜下多血管炎(MPA)肺损害患者的临床特点。方法:对20例伴肺部损害的MPA患者临床资料进行回顾性分析,包括临床表现、实验室检查、肺部高分辨率CT(HRCT)、肺功能及病理活检。结果:20例肺部受累的MPA,常见肺部症状有咳嗽(占85%)、呼吸困难(占30%)、咳痰(占25%)和咯血(占20%)。95%(19/20)的患者血沉加快,55%(11/20)的患者C反应蛋白升高。90%(18/20)的患者抗髓过氧化物酶抗体(MPO-ANCA)阳性,5%(1/20)的患者抗蛋白酶3抗体(PR3-ANCA)阳性,5%(1/20)的患者MPO-ANCA、PR3-ANCA均阴性。肺部HRCT表现有磨玻璃影、肺间质纤维化、斑片浸润影、胸腔积液和支气管扩张。结论:MPA常累及肺部,可以肺部症状为首发临床表现,肺部受累的MPA临床表现及肺部HRCT影像学无明显特异性,及早予以ANCA检测及组织病理活检,以便早期诊治。

Objective： To analyze the clinical characters of pulmonary involvement in the patients with microscopic polyangiitis. Methods： Twenty cases of MPA with pulmonary involvement were analyzed retrospectively, including clinical manifestation, laboratory test results, chest high-resolution computed tomography, pulmonary function test and pathology. Results： The common symptoms were cough （85%）, dyspnea （30%）, expectoration （25%） and haemoptysis （20%）. Erythrocyte sedimentation rate was elevated in 95% of MPA patients. C-reactive protein was elevated in 55%. The prevalence of positive MPO-ANCA antibodies in MPA patients was 90%, while PR3-ANCA was 5%. Chest HRCT manifestations consisted of ground-glass opacity, interstitial fibrosis, patchy infiltration, pleural effusion and bronchiectasis. Conclusions： The pulmonary is frequently involved in MPA. Pulmonary involvement is the initial manifestation. The chest radiographic and clinical manifestations are nonspecific. Serum ANCA and histopathologic biopsy can help to understand and diagnose MPA with pulmonary involvement early.