抗中性粒细胞胞质抗体相关性血管炎合并肺间质病变的临床特点和相关因素分析

Clinical characteristics and correlative factors analysis of ANCA-associated vasculitis with interstitial lung disease

目的 了解ANCA相关性血管炎（AASV）合并肺间质病变（ILD）的临床特点和相关危险因素.方法 选择上海交通大学医学院附属仁济医院风湿科2010年1月至2013年6月确诊75例AASV住院患者为研究对象,回顾性分析其中合并ILD病例的临床特点,采用Logistic回归模型进行AASV合并ILD相关危险因素分析.结果 75例AASV患者男性占52％,女性占48％,平均年龄（56±19）岁.其中44例合并ILD,慢性起病31例（70％）,肺部感染32例（73％）,死亡8例（18％）.主要表现为干咳（30例,68％）、活动后气促（16例,36％）、发热（22例,50％）.影像学改变以不规则线样影为主（55％）,肺功能表现为不同程度弥散功能减退（16例）.Logistic多因素分析结果显示：年龄＞60岁（OR=3.44,95％CI：1.05～11.28）、髓过氧化物酶（MPO）-ANCA阳性（OR=3.73,95％CI：1.10～12.65）、伯明翰系统性血管炎活动性指数（BVAS）≥15分（OR =3.67,95％CI：1.21～11.15）易合并ILD.结论 ILD是AASV常见肺损害,会因呼吸衰竭或继发肺部感染而导致死亡,老年、MPO-ANCA阳性和疾病活动患者合并ILD的风险高,临床中应给予重视.

Objective To understand the clinical characteristics and correlative factors of ANCA-associated systemic vasculitis with interstitial lung disease.Methods Seventy-five AASV patients in Shanghai Renji Hospital from January 2010 to June 2013 were selected.The clinical data of those cases with interstitial lung disease were analyzed retrospectively and logistic regression model was applied to analyze the correlative factors.Results Of the 75 AASV patients,52% were male,48% were female,and the average age was （56±19） years.Forty-four cases were defined as interstitial lung disease.Among patients with interstitial lung dis-ease,31 （70%） cases were chronic onset,32（72%） cases had pulmonary infection and 8 （18%） cases died.The main chnical manifestations were dry cough,shortness of breath after labour and fever,the proportion was 68%,36% and 50% respectively.Irregular linear shadow was the main imagine changes,the rate was 55%.Pulmonary function changes varied in degrees with diffusion capacity reduction.Multivariate logistic regres-sion analysis showed that those who were older than 60 years （OR=3.44,95%CI：1.05-11.28）,positive for MPO-ANCA （OR=3.7,95%CI：1.10-12.65） and Birmingham vasculitis activitv score higher than15 （OR=3.67,95%CI：1.21-11.15） were more likely to have interstitial lung disease.Conclusion Interstitial lung disease is one of the common pulmonary damages of ANCA-associated systemic vasculitis and it will lead to death because of respiratory failure or secondary pulmonary infection.Those who are elders,with positive MPO-ANCA,and with active disease are at high risk for interstitial lung disease among AASV patients.The results of this study sugest that clinicians should pay more attention to patients with these high risk factors.