嗜酸性肉芽肿性多血管炎肾受累的临床分析

Clinical analysis of renal involvement in eosinophilic granulomatosis with polyangiitis

目的分析嗜酸性肉芽肿性血管炎(eosinophilic granulomatosis with polyangiitis,EGPA)患者肾受累的临床特点。方法分析2005年5月至2021年12月首都医科大学附属北京朝阳医院收治的确诊EGPA患者的临床资料,分析EGPA患者肾受累的临床特点,通过慢性肾病组和对照组之间的差异分析,发现EGPA合并肾受累的危险因素。结果104例EGPA患者中,男性55例,女性49例,确诊时中位年龄56(46,65)岁。最常见的临床症状是哮喘,共99例(95.2%)。82例(78.8%)患者伴有嗜酸性粒细胞增多超过10%。20例(19.2%)患者抗中性粒细胞胞质抗体(antineutrophil cytoplasmic antibody,ANCA)阳性。肾受累患者共59例(56.7%),其中镜下血尿30例(28.8%),蛋白尿11例(10.6%),肾小球滤过率(estimated Glomerular Filtration Rate,eGFR)下降[eGFR<80 mL/(min·1.73 m 2)]38例(36.5%),慢性肾病[eGFR<60 mL/(min·1.73 m 2)]11例(10.6%)。ANCA阳性组患者中的肾损伤发生率明显高于ANCA阴性组。伴有慢性肾病的EGPA患者中血红蛋白浓度有显著下降(U=212.50,P=0.002),心脏受累发生率显著增加(χ^(2)=5.610,P=0.018)。多因素分析提示,高龄及ANCA阳性是EGPA肾受累的独立危险因素。随访中位时间41(19,59)个月,6例患者死亡,其中3例伴有肾受累。结论EGPA患者中肾受累主要表现为镜下血尿、蛋白尿和轻度肌酐清除率下降。慢性肾病患者同时伴有贫血和心脏受累的发生率增高。高龄及ANCA阳性是肾损害的独立危险因素。

Objective To describe the clinical features of renal involvement with eosinophilic granulomatosis with polyangiitis(EGPA)in patients.Methods Patients who fulfilled the criteria of EGPA managed at the Beijing Chaoyang Hospital,Capital Medical University from May 2005 to December 2021 were retrospectively analyzed.The clinical data of patients with renal involvement were analyzed,the differences between patients with and without chronic kidney disease were compared.The risk factors of EGPA with renal involvement were analyzed.Results Among 104 patients with EGPA,55 were males and 49 were females,with a median age of 56(46,65)years at the time of diagnosis.Asthma was the most common symptom in 99 patients(95.2%),82 patients(78.8%)with eosinophilia(>10%),ANCA was positive in 20 patients(19.2%).There were 59 patients(56.7%)with renal involvement,including 30 patients(28.8%)with microscopic hematuria,11 patients(10.6%)with proteinuria,38 patients(36.5%)with decreased estimated glomerular filtration rate[eGFR<80 mL/(min·1.73 m 2)],and 11 patients(10.6%)with chronic kidney disease[eGFR<60 mL/(min·1.73 m 2)].ANCA positive patients were more likely to have renal involvement than ANCA negative patients.In patients with chronic kidney disease,the hemoglobin level was significantly decreased(U=212.50,P=0.002),and the incidence of heart involvement was significantly increased(χ^(2)=5.610,P=0.018).Multivariate analysis suggested that advanced age and ANCA positive were independent risk factors for EGPA renal involvement.The median follow-up time was 41(19,59)months,6 patients died,3 with chronic kidney disease.Conclusions Renal involvement in patients with EGPA is mainly manifested by hematuria,proteinuria and a mild decreased renal function.Advanced age and ANCA positive are independent risk factors for renal involvement.Patients with chronic kidney disease have an increased incidence of both anemia and cardiac involvement.