丙基硫氧嘧啶致儿童抗中性粒细胞胞浆抗体阳性新月体肾炎1例及文献复习

Propylthiouracil induced crescentic glomerulonephritis with positive ANCA in children:report of one case and review of literature

目的 分析儿童丙基硫氧嘧啶 (PTU)致抗中性粒细胞胞浆抗体 (ANCA)阳性新月体肾炎的临床、病理特点及发病机制。方法 对 1例PTU致ANCA阳性新月体肾炎患儿的临床、实验室资料、病理进行分析 ,并复习相关文献。结果 本例ANCA阳性新月体肾炎患儿有PTU服用史 ;临床上有血尿、蛋白尿、肾功能损害 ,贫血 ,咳嗽、咯血痰、肺部湿音 ,ANCA阳性 ,P ANCA、抗单氧化酶阳性 ,血沉快 (70mm/h) ,血γ 球蛋白增高 ,抗肾小球基底膜抗体阴性 ;肾脏病理改变以细胞性新月体为主 ,免疫荧光IgG(++) ,IgA(+) ,IgM、C3 、纤维蛋白均阴性。经皮质激素治疗 ,肾功能恢复正常 ,临床表现改善。结论 PTU可致儿童ANCA阳性新月体肾炎 ,其临床表现、肾脏病理改变与成人相似 ,但有其自身特点。

Objective To study the clinical and pathological characteristics of crescentic glomerulonephritis with positive anti-neutrophil cytoplasmic antibody (ANCA) induced by propylthiouracil.Methods Clinical laboratory and pathogical data of the child were collected and analyzed,and the relative literature was reviewed.Results Except hematuria,proteinuria,impaired damaged renal function,anemia,cough,accelerated ESR(erythrocyte sedimentation rate) and elevated gammaglobulins,the child also had positive ANCA(P-ANCA) and microperoxidase(MPO),cellular crescent formation of the glomerular.The immunofluorescent IgG and IgA were positive and IgM,C 3 and fibrin were negative.Following the immunosuppression therapy with corticosteroids,both the symptoms and renal function of the child improved.Conclusion Crescentic glomerulonephritis with positive ANCA in children can be induced by propylthiouracil.The clinical and pathological characteristics in children are similar to those in adults.