34例不明原因发热起病MPO-ANCA阳性患者随访分析

A follow up study in 34 patients with MPO-ANCA positive caused by fever of unknown origin

目的初步探讨抗髓过氧化物酶中性粒细胞抗体(MPO-ANCA)阳性在不明原因发热(FUO)患者中的临床意义。方法 34例FUO伴MPO-ANCA阳性患者纳入本研究,记录并分析其临床资料及诊治随访过程的病情变化。结果34例患者中9例考虑与感染和药物相关的MPO-ANCA阳性(A组),其余25例发展为典型的抗中性粒细胞胞质抗体相关性血管炎(AAV)(B组)。两组间比较,B组患者红细胞沉降率(P=0.002)、血清铁蛋白(P=0.002)、MPO-ANCA水平(P=0.001)差异有统计学意义;B组较A组患者伯明翰血管炎活动度评分(BVAS)(P=0.002)及损害器官数(P=0.044)更高,其中,肾功能损害在B组更加明显,血肌酐值更高(P=0.005);B组中MPO-ANCA与BVAS间存在显著的相关性(P=0.036),A组中这种相关性并不明显(P=0.503)。与B组相比,A组患者经积极处理相关病因,AAV病情较轻且容易控制。结论检测FUO患者MPO-ANCA有助于病因诊断,MPO-ANCA阳性的FUO患者多为典型的抗中性粒细胞胞质髓过氧化物酶抗体相关性血管炎(MPOAAV)的早期表现,少数可能由其他疾病(感染、药物等)诱发,识别后者并积极处理,对确定合理治疗方案非常重要。

Objective To preliminarily investigate and discuss the clinical significance of positive myeloperoxidase anti-neutrophil cytoplasmic antibodies （MPO-ANCA） in patients with fever of unknown origin（FUO）. Methods Thirty-four patients suffered from FUO with MPO-ANCA positive were enrolled in this study. The clinical data and their condition changes during the procedures diagnosis, treatment and follow-ups were recorded and analyzed. Re-sults 9 in 34 patients were deemed as infection-associated MPO-ANCA positive （group A） while the rest 25 pa-tients were developed to typical ANCA-associated vasculitis （ AAV） （ group B）. Comparison between the two groups showed that the differences of blood sedimentation （P = 0. 002）, serum ferritin（P = 0. 002） and MPO-AN-CA level （ P = 0. 001） in group B had statistical significance. Patient′ s Birmingham vasculitis activity score （BVAS） （P = 0. 002） and number of damaged organs （P = 0. 044） in group B were higher than those of group A, of which the renal dysfunction was even more significant in group B, showing in serum creatinine （P = 0. 005）.There was a significant correlation （P = 0. 036） between MPO-ANCA and BVAS in group B while it was not signifi-cant （P = 0. 503） in group A. Compared with group B, patients＇AAV conditions seemed mildly and easily to con-trol in group A after positively dealing with relevant etiological factors. Conclusion It will contribute to etiological diagnoses by testing MPO-ANCA in patients with FUO. MPO-ANCA positive in majority of patients with FUO is an early symptom of typical MPO-AAV. Minority may be induced by other diseases （infection and drugs, etc. ）. It will be positively treated after confirmation. It is very important to make sure of a reasonable treatment regimen.