14例抗中性粒细胞胞浆抗体相关性小血管炎并发心肌炎临床分析

Clinical analysis of 14 cases of anti-neutrophil cytoplasmic antibody associated small vasculitis complicated with myocarditis

目的分析抗中性粒细胞胞浆抗体相关性小血管炎(AAV)并发心肌炎患者的临床资料,以提高对该病的认识。方法回顾性分析2012年1月至2017年6月北京协和医院诊断为AAV并发心肌炎的14例住院患者的临床资料、治疗和预后,总结AAV并发心肌炎的特征。结果评价心肌损伤指标N末端-脑钠肽前体(NT-proBNP)、肌钙蛋白、射血分数(EF)与红细胞沉降率、C反应蛋白(CRP)、伯明翰血管炎活动指数评分及5因子评分无相关性(P>0.05);嗜酸细胞性肉芽肿性多血管炎(EGPA)患者较显微镜下多血管炎(MPA)和肉芽肿性多血管炎(GPA)患者肌钙蛋白水平升高(P=0.032);AAV并发心肌炎死亡患者的5因子评分高于存活患者(P=0.035)。结论AAV并发心肌炎出现于疾病活动期,病情严重,早期诊断、积极治疗为提高预后的关键措施。

Objective To analyze the clinical data of patients with anti-neutrophil cytoplasmic antibody associated vasculitis(AAV)complicated with myocarditis,in order to reinforce understanding of the disease.Methods The clinical data,treatment and prognosis of 14 hospitalized patients diagnosed with AAV complicated with myocarditis from January 2012 to June 2017 in Peking Union Medical College Hospital were retrospectively analyzed,and the characteristics of AAV complicated with myocarditis were summarized.Results No correlation was observed between myocardial injury indicators,including N-terminal-brain natriuretic peptide(NT-proBNP),troponin,ejection fraction(EF),and erythrocyte sedimentation rate,C-reactive protein(CRP),Birmingham vasculitis activity index score and 5-factor score(P>0.05).The level of troponin in patients with eosinophilic granulomatous with polyangiitis(EGPA)was significantly elevated,compared with that in patients with microscopic polyangiitis(MPA)and granulomatous with polyangiitis(GPA)(P=0.032).The 5-factor score in death patients with AAV complicated with myocarditis was higher than that of those survivors(P=0.035).Conclusion AAV complicated with myocarditis occurs in the active stage of the disease,and the condition is serious.Early diagnosis and active treatment are the key to improve the prognosis.