抗中性粒细胞胞质抗体相关性血管炎合并慢性鼻窦炎17例临床分析

Clinical analysis of 17 cases of anti-neutrophil cytoplasmic antibody associated vasculitis combined with chronic rhinosinusitis

目的分析抗中性粒细胞胞质抗体(anti-neutrophil cytoplasmic antibodies,ANCA)相关性血管炎(ANCA-associated vasculitis,AAV)合并慢性鼻窦炎(chronic rhinosinusitis,CRS)患者的临床特点,探讨其诊断策略。方法回顾性分析2008年8月至2018年6月期间华中科技大学同济医学院附属同济医院收治的228例AAV患者,对其中17例(7.5%,17/228)合并CRS的患者(男10例,女7例,年龄17~67岁)的临床表现、实验室检查、治疗及预后等情况进行归纳分析。结果17例合并CRS的AAV患者除具有鼻塞及鼻分泌物增多等表现外,患者还伴有咳嗽、喘息等肺部症状(5/17)以及发热(7/17)和贫血(7/17)等全身表现。实验室检查可见ANCA检测阳性(14/17)、C反应蛋白增高(9/17)、以及血尿(8/17)和蛋白尿(6/17)。有2例患者要求外院治疗,其他15例患者经糖皮质激素和免疫抑制剂治疗后,大多数(14/15)病情可缓解。结论AAV合并CRS的患者可出现全身和肺部症状(咳嗽、哮喘、发热、贫血等)或某些实验室检查阳性(C反应蛋白增高、蛋白尿或血尿等),对这类患者应行ANCA检测和病理检查,以达到早期确诊的目的。

Objective To analyse the clinical characteristics of patients of anti-neutrophil cytoplasmic antibodies (ANCA)-associated vasculitis (AAV) combined with chronic rhinosinusitis (CRS) and its diagnostic strategy. Methods A retrospective analysis of 228 patients with AAV treated in Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology from August 2008 to June 2018 was performed. Among them, 17 (7.5%, 17/228) patients(10 males and 7 females, with the range of age from 17 to 67 years old) had CRS and their clinical manifestations, laboratory examinations, treatment and prognosis were summarized and studied. Results In addition to nasal obstruction and increased nasal secretion, 17 AAV patients with CRS were accompanied by cough, wheezing and other pulmonary symptoms (5/17), fever (7/17) and anemia (7/17). Laboratoy tests showed positive ANCA (14/17), increased C-reactive protein (9/17), haematuria (8/17) and proteinuria (6/17). Except for 2 patients who went to other hospital, most patients (14/15) were relieved by glucocorticoid and immunosuppressive therapy. Conclusions AAV patients with CRS may be accompanied by systemic and pulmonary symptoms (cough, asthma, fever, anemia, etc) or some positive laboratory tests (elevated C-reactive protein, proteinuria and/or hematuria, etc.). To achieve the goal of early diagnosis of AAV, ANCA test and biopsy are recommended for those patients with AAV and CRS concurrently.