肾脏有免疫复合物沉积的小血管炎的临床病理特点

Clinical and pathological charactcristics of ANCA associated systemic vasculitis with immune complex deposition in kidney

目的 回顾性总结分析肾脏有免疫复合物沉积的ANCA相关系统性血管炎(AASV)患者的临床和病理特点。方法 将近5年在北京大学第一医院住院诊断为AASV且肾活检免疫荧光显示系膜区有免疫复合物沉积(免疫球蛋白≥++)的患者与同期少免疫复合物沉积的患者的临床和病理进行比较。结果 肾脏有免疫复合物沉积者8例(IgM沉积5例,IgA沉积2例,IgG沉积1例),肾脏少免疫复合物沉积者32例。2组在性别、年龄、ANCA类型、起病至肾活检的时间、临床表现以及短期肾脏存活率方面差异均无显著性意义,仅前组患者在有前驱感染方面显著多于后组(P<0.05)。结论 肾脏有免疫复合物沉积的AASV的临床与病理特点与普通的AASV基本一致,应引起高度重视,而需要针对AASV的强化免疫抑制治疗。

Objective To analyze the clinical and pathological characteristics of ANCA associated systemic vasculitis(AASV) with immune complex deposition in kidney and compare with that of pauci-immune AASV. Methods Patients with AASV, admitted in our hospital in last 5 years, were retrospectively studied. The clinical and pathological characteristics were compared between patients with immune complex deposition and patients with pauci-immune deposition. Results There were eitht patients with immune complex deposition (five with IgM deposition, two with IgA deposition and one with IgG deposition) and 32 patients with pauci-immune deposition. There was no significant difference in age, gender, type of ANCA, interval between onset of vasculitis and renal biopsy, clinical manifestations and short-term renal survival rate between the two groups. Patients with immune complex deposition had a higher predromal infection rate ( P < 0. 05). Conclusion The clinical and pathological characteristics of patients with AASV with immune complex deposition in kidney are similar with pauci-immune AASV and they should be treated with intensive immunosuppressive therapy.