抗中性粒细胞胞浆抗体相关血管炎肺损害的临床特点及影响因素分析

Analysis of Clinical Characteristics and Influence Factors of Lung Involvement in ANCA-associated Vasculitis

目的分析抗中性粒细胞胞浆抗体(ANCA)相关血管炎(AAV)肺损害患者临床特点及其影响因素,旨在提高临床医师对AAV肺损害患者早期诊治能力,从而改善疾病预后。方法回顾性分析2012年1月至2022年4月宁夏医科大学总医院确诊为AAV的84例患者临床资料,根据有无肺部受累分为ANCA组和ANCA-ILD组,比较两组的临床资料;通过Logistic回归模型分析AAV肺损害的影响因素。结果84例AAV患者中,ANCA-ILD组48例(57.1%),ANCA组36例(42.9%)。与ANCA组比较,ANCA-ILD组发病平均年龄更高[(55.65±14.14)岁vs(36.19±14.13)岁,t=-6.242,P<0.001]。ANCA-ILD组临床表现以咳嗽、血痰、气短为主,ANCA组以皮疹、雷诺现象多见(P均<0.05)。MPO-ANCA与PR3-ANCA在ANCA-ILD组呈现更高的阳性率(P<0.05)。ANCA-ILD组在不同临床亚组(GPA,MPA)间的肺部CT严重程度比较,差异无统计学意义(P=0.621)。而GPA多表现为结节、肿块、空洞,MPA则以UIP型及NSIP型更多见(P均<0.05)。多因素Logistic回归分析显示,年龄、MPO-ANCA阳性与AAV肺损害具有相关性(P均<0.05)。结论GPA多以结节、肿块、空洞常见,MPA则以UIP型及NSIP型更多见。年龄、MPO-ANCA阳性是AAV肺损害的主要影响因素。

Objective To analyze the clinical characteristics and influence factors of lung involvement in anti-neutrophil cytoplasmic antibody(ANCA)associated vasculitis(AAV),in order to diagnosis and develop effective treatment early,so as to improve the prognosis of lung involvement in AAV.Methods The clinical data of 84 patients with AAV diagnosed in General Hospital of Ningxia Medical University from January 2012 to April 2022 were collected and retrospectively analyzed.They were divided into the ANCA group and the ANCA-ILD group according to whether they were lung involvement or not.The clinical data of the two groups were analyzed and compared,and the influence factors of lung involvement in AAV were analyzed by Logistic regression model.Results Of the 84 patients with AAV,48 patients in the ANCA-ILD group(57.1%)and 36 patients in the ANCA group(42.9%).There was significant difference in average age of onset between the two groups.Compared with the ANCA group,the ANCA-ILD group was higher(55.65±14.14 vs 36.19±14.13,t=-6.242,P<0.001).The main clinical manifestations were cough,bloody sputum and shortness of breath in the ANCA-ILD group,while rash and Raynaud phenomenon was common in the ANCA group(P all<0.05).The positive rates of MPO-ANCA and PR3-ANCA were higher in the ANCA-ILD group(P<0.05).There were no significant differences in the severity of pulmonary CT among different clinical subgroups(GPA,MPA)in the ANCA-ILD group(P=0.621).The most common imaging manifestations of GPA were nodules,masses and cavities,while UIP and NSIP were more common in MPA(P all<0.05).Multivariate Logistic regression analysis showed that age and MPO-ANCA were correlated with lung involvement in AAV(P all<0.05).Conclusion Nodules,masses and cavities were more common in GPA,while UIP and NSIP were more common in MPA.Age and MPO-ANCA are the influence factors of lung involvement in AAV.