抗肾小球基底膜抗体阳性伴抗中性白细胞胞质抗体阳性患者的临床特征及预后分析

Analysis of clinical features and prognosis of anti- glomerular basement membrane antibody positive patients with antineutrophil cytoplasmic antibodies

目的分析血清抗中性白细胞胞质抗体（ANCA）及抗肾小球基底膜抗体（Anti-GBM）双阳性肾炎患者的临床病理特点及预后。方法对2010年至2015年在南京医科大学第一附属医院肾内科住院确诊Anti—GBM肾炎的23例患者进行血清ANCA检测，对其中7例ANCA阳性患者在临床病理及预后等方面进行分析，并与血清ANCA阴性Anti—GBM肾炎患者进行比较。结果23例Anti-GBM肾炎患者有7例（30．4％）同时存在血清ANCA阳性，其中髓过氧化物酶．ANCA（MPO—ANCA）阳性者7例（100％），蛋白酶3．ANCA（PR3-ANCA）阳性者1例[14．3％，该例同时合并MPO—ANCA阳性]。血清ANCA阳性Anti—GBM肾炎患者肉眼血尿及咯血的发生率显著高于ANCA阴性Anti—GBM肾炎患者（P〈0．05），两组在发病年龄、性别、其他临床表现、病理改变方面差异均无统计学意义，且两组预后均较差。结论ANCA阳性抗GBM肾炎患者肉眼血尿及咯血的发生率显著高于ANCA阴性抗GBM肾炎组，但两组患者的预后均较差。

Objective To investigate the characteristics and outcome of glomerulonephritis in patients with both antineutrophil cytoplasmic antibody and anti- glomerular basement membrane antibody. Methods The sera of 23 anti-GBM glomerulonephritis patients were collected and were tested for ANCA respectively. Characteristics and outcome of patients with coexisting anti- GBM antibody and ANCA were analyzed, and were compared with anti- GBM glomerulonephritis patients without coexisting ANCA. Results Among the 23 sera with anti- GBM antibody, 7 sera had coexisting ANCA （7 MPO- ANCA, 1 PR3- ANCA）, which represented 30.4% of the anti- GBM glomerulonephritis patients. The incidence of hemoptysis and hematuria in ANCA ＋-anti- GBM glomerulonephritis group was significantly higher than that in ANCA-anti- GBM glomerulonephritis group （P 〈 0.05）. No significant difference in age, sex, other clinical manifestations and pathological features were found between patients with and without coexisting serum ANCA. Conclusion The incidence of hemoptysis and hematuria in ANCA＊-anti-GBM glomerulonephritis group is significantly higher than that in ANCA--anti- GBM glomerulonephritis group, but the prognoses of the two groups were poor.