老年抗中性粒细胞胞质抗体相关性血管炎伴肾损伤患者的临床特点、病理和预后分析

Clinical Characteristics and Renal Outcome in Elderly Patients with Antineutrophil Cytoplasmic Autoantibody Associated Vasculitis with Renal Involvement

目的分析老年抗中性粒细胞胞质抗体(ANCA)相关性血管炎合并肾损伤患者的临床特点、肾脏病理改变及其预后。方法回顾性分析2006年6月-2012年6月期间住院的ANCA相关性血管炎患者147例,根据年龄分组,≥65岁患者为老年组(n=50),<65岁为非老年组(n=97),对比分析两组患者的病程、临床特点、ANCA血清学指标、肾脏病理改变及预后。结果老年组3例韦格纳肉芽肿(WG),45例显微镜下小血管炎(MPA),2例寡免疫复合物新月体肾炎(PICGN);非老年组8例WG,82例MPA,6例PICGN,1例过敏性肉芽肿性血管炎。ANCA血清学指标老年组中有5例患者胞质型ANCA阳性,44例核周型ANCA阳性。老年组患者肺损害的比例高于非老年组,组间比较差异有统计学意义(P=0.030)。两组患者合并肺部感染以及合并炎症指标C反应蛋白组间比较差异无统计学意义(P=0.281;P=0.326)。8例老年ANCA相关性血管炎患者行肾活体组织检查,病理发现新月体性肾小球肾炎6例(75.0%)。老年患者使用激素冲击治疗以及合并环磷酰胺治疗率低于非老年组(P=0.035,P=0.043);老年组复发率高于非老年组(P=0.040)。结论 ANCA相关性血管炎合并肾脏损伤以中老年患者多见,发病时合并肺受累多;老年患者使用激素冲击治疗以及联合环磷酰胺使用的比例较低,二者与血管炎复发率相关。

Objective To analyze the clinical characteristics and renal outcome of elderly patients with antineutrophil cytoplasmic autoantibody （ANCA） associated vasculitis （AAV） with renal involvement. Methods We retrospectively analyzed the clinical data of 147 patients with ANCA relate vasculitis treated between June 2006 and June 2012. Based on the age, the patients were divided into elderly group （65 years or older, n=50） and non-elderly group （younger than 65, n=97）. The disease course, clinical characteristics, ANCA serological indexes, renal pathological change and prognosis of patients in the two groups were compared and studied. Results In the elderly group, there were 3 cases of Wegener granulomatosis （WG）, 45 of microscopic polyangiitis （MPA）, and 2 of pauci-immune crescentic glomerulonephritis （PICGN）. The non-elderly group had 8 cases of WG, 82 of MPA, 6 of PICGN, and 1 of allergic angitis granulomatosis. There were 5 cases of positive cANCA and 44 of positive pANCA in the elderly group. The elderly patients had significantly more pulmonary involvement than the younger patients （P=-0.030）. No significant difference was detected between the two groups in combined pulmonary infection （P=0.281） or combined infectious index C-reactive protein （P=0.326）. Elderly patients were less likely to respond to sufficient treatment with pulse intravenous methylprednisolone therapy （P=0.035） and cyclophosphamide （P=0.043）, and had worse renal outcome than younger patients （P=0.040）. Conclusion Elderly patients with AAV have more prevalent pulmonary involvement and have severe complication of pulmonary infection, which affects mortality and morbidity of ANCA-associated systemic vasculitis.