10例丙基硫氧嘧啶诱发抗中性粒细胞胞质抗体阳性患者的临床特点

Clinical Characteristics of 10 Cases with Propylthiouracil(PTU)Induced Antineutrophil Cytoplasmic Antibodies Positive Patients

目的分析丙基硫氧嘧啶(PTU)导致抗中性粒细胞胞质抗体阳性病例的临床特点。方法回顾2012年1月至2018年12月10例PTU诱发ANCA阳性患者的流行病学特征、临床、实验室检查、治疗及转归。结果10例患者,甲状腺功能亢进症病程(6.80±5.70)年,PTU使用时间(4.30±4.50)年。血尿8例,蛋白尿9例,肾功能不全4例,咯血2例,消化道出血1例,血栓1例。治疗上:糖皮质激素7例,其中4例联合免疫抑制剂治疗。随访(3.10±1.60)年,4例肾功能不全者中,1例进展至尿毒症,3例肾功能恢复正常;9例尿检异常者,1例尿蛋白持续阳性,8例尿常规恢复正常;非特异性症状在停用PTU或糖皮质激素治疗后缓解。结论接受PTU治疗超过6个月的患者,若出现血尿、蛋白尿或肾功能异常,需警惕血管炎;出血、血栓等也可能是血管炎的非特异表现,应及时检测ANCA。有内脏受累的PTU相关性小血管炎患者,除停用PTU外,还需接收免疫抑制治疗。

Objective To study the PTU induced ANCA positive cases.Methods Review epidemiological characteristics,clinical and laboratory examination,treatment and outcome of 10 PTUassociated ANCA positive patients from January 2012 to December 2018.Results Ten patients with hyperthyroidism(6.80±5.70)years and using PTU for about(4.30±4.50)years were 8 hematuria,9 albuminuria,4 renal insuffi ciency,2 hemoptysis,1 gastrointestinal bleeding,1 thrombosis.Treatment there were 7 glucocorticoids and 4 combined immunosuppressive therapy.Follow-up(3.10±1.60)years,among the 4 patients with renal insllffi ciency,1 progressed to uremia,and 3 patients returned to normal renal function;amnong 9 patients with abnormal ruine test,1 patient had persistently positive ruine protein,and 8 patients returned to normal urine routine.Nonspecific symptoms were relieved after stopping using PTU or glucocorticoid therapy.Conclusion The patients with PTU therapy for more than 6 months should be care for vasculitis if hematuria,proteinuria or abnormal renal function occurs and should be detected ANCA if with the non-specifi c performance of bleeding and thrombosis.In addition to discontinuation of PTU,immunosuppressive therapy is needed for patients with visceral involvement.