微型多动脉炎的肾脏损害(附8例报告)

RENAL LESIONS IN MICROSCOPIC POLYARTERITIS NODOSA: A REPORT OF EIGHT CASES

本文分析微型多动脉炎(microscopic polyarteritis nodosa,MPAN)8例病人的临床,实验室检查及肾脏病理特点。结果发现,除发热、肌痛等一般症状外,最常受累的是血液系统,消化系统和心血管系统。肾脏病病情发展急骤,迅速出现肾功能损害。实验室检查常见肾功能不全,贫血和白细胞增多,60％的病例抗白细胞胞浆抗体阳性。肾活检光镜特征为局灶性、节段性、坏死性肾小球肾炎,伴新月体形成和血管炎/坏死。作者认为,MPAN病程常多迁延,预后不佳。鉴于本病缺乏特异性诊断方法,血管造影也有一定局限性,在临床上疑及本病时应及早作肾活检,有助于诊断。

A clinico-pathological study was carried out on 8 patients with microscopic polyar-teritis nodosa (MPAN). It was found that the renal lesions were very common and severe in this group of patients apart from the typical presentation of MPAN, including fever, myalgias, arteritis and the involvement of hematologic, gastrointestinal and cardiovascular systems. Laboratory pictures were characterized by leucocytosis, anemia and increased serum creatinine. The plasma anti-neutrophil cytoplasmic antibodies were present and thought to be of particular importance. On light microscopy, focal, segmental necrotising glomerulonephritis was discovered which was often associated with extensive crescence formation and vasculitis. We recommend renal biopsy as a valuable tool of investigation in the diagnosis of MPAN.