82例ANCA阳性相关性血管炎的临床特点分析

发布时间：2018-03-03 00:26

本文选题：抗中性粒细胞胞质抗体　切入点：血管炎　出处：《广西医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:分析82例初诊的ANCA阳性相关性血管炎临床特点,旨在提高对该病的认识。方法:回顾性分析广西医科大学第一附属医院2015年1月至2016年12月初诊的82例符合ANCA阳性相关性血管炎诊断患者的病历资料,如基本资料(如年龄、性别、入院诊断、首诊科室等)、临床症状及辅助检查资料。结果:82例患者中男28例,女54例,男女之比为1:1.926,平均年龄为58.45±15.77岁,平均首诊时间为3个月,其临床症状不具有特异性,常常表现为肾脏受累(如血尿、蛋白尿、肌酐升高)、全身症状(如纳差、乏力、发热、消瘦)以及呼吸道症状(如咳嗽、咳痰、咯血)等,大约89%患者被误诊为其他疾病,如肾功能不全、肺炎等。实验室检查结果:82例患者中MPO-ANCA阳性74例,PR3-ANCA阳性8例,两者比9.25:1,平均抗体滴度为1:50.45;除此之外白细胞升高34例(41.46%),中性粒细胞百分比升高44例(53.55%),血红蛋白降低78例(95.12%),ESR升高79例(96.34%),CRP升高76例(92.68%),肌酐升高59例(71.95%)。大多数患者(81.58%)血清高密度脂蛋白明显下降。咳嗽、咳痰、咯血、超敏C反应蛋白升高、血沉升高在AAV肺脏受累组与非肺脏受累组间的差异具有统计学意义(P0.05)。Logistic多因素分析示:超敏C反应蛋白升高(OR=1.009,95%Cl 0.999~1.018,P=0.069),血沉升高(OR=1.010,95%Cl 0.996~1.025,P=0.162),超敏C反应蛋白升高和血沉的升高与AAV是否肺脏受累无相关性。组织病理学结果:球性硬化32例,新月体形成19例,小管受累14例,局灶节段坏死8例,系膜增生3例;1例皮肤组织病理示真皮血管周中等量中性白细胞浸润。胸部CT结果:以间质性改变为主,以磨玻璃影、网格状、结节影、实变影、蜂窝状、小叶间隔增厚改变为多见,可伴随有胸腔积液、胸膜增厚、淋巴结肿大、肺气肿、气管扩张、空洞、淋巴结钙化等表现,病灶的分布特点:对称、广泛、散在、以中下肺为主。结论:ANCA阳性相关性血管炎好发于中老年女性,大多数患者MPO-ANCA阳性。ANCA阳性相关性血管炎肺脏的受累率为43.9%,临床表现缺乏特异性,易被误诊其他肺部疾病。胸部CT常表现为两肺形态各异、密度不均、边界不规则的渗出影,病灶呈对称分布,主要集中在中下肺。绝大多数ANCA阳性相关性血管炎患者血清高密度脂蛋白显著下降。
[Abstract]:Objective: to analyze the clinical characteristics of 82 cases of ANCA positive associated vasculitis. Methods: 82 cases of ANCA positive associated vasculitis diagnosed from January 2015 to December 2016 in the first affiliated Hospital of Guangxi Medical University were analyzed retrospectively. Results among 82 patients, 28 were male and 54 were female, the ratio of male to female was 1: 1.926, the average age was 58.45 卤15.77 years, and the average first visit time was 3 months. Its clinical symptoms are not specific and are often characterized by kidney involvement (e.g. hematuria, proteinuria, creatinine elevation), systemic symptoms (such as anorexia, fatigue, fever, emaciation) and respiratory symptoms such as cough, expectoration, hemoptysis, etc. About 89% patients were misdiagnosed as other diseases, such as renal insufficiency, pneumonia, etc. Laboratory tests showed that 74 of 82 patients were MPO-ANCA positive and 8 were positive for PR3-ANCA. The ratio is 9.25: 1, the average titer of antibody is 1: 50.45; in addition, there are 34 cases of leukocytosis and 41.46% increase, 44 cases of increased percentage of neutrophils, 44 cases of increase of neutrophil percentage and 44 cases of increase of neutrophil percentage, 78 cases of hemoglobin decrease and 78 cases of decrease of hemoglobin in 78 cases. There are 79 cases of elevated CRP in 76 cases and creatinine in 59 cases (71.95%). Most patients have 81.58% of blood. Clear high density lipoprotein decreased markedly. Cough, Expectoration, hemoptysis, hypersensitive C-reactive protein increase, The difference of ESR between AAV lung involvement group and non-pulmonary involvement group was statistically significant (P 0.05). Logistic multivariate analysis showed that: hypersensitive C-reactive protein increased 1.009 ~ 95Cl 0.999 ~ 1.018L P0.069, ESR was 1.01095 Cl 0.9961.025P0. 162, hypersensitive C-reactive protein increased and erythrocyte sedimentation rate increased and erythrocyte sedimentation rate increased. There was no correlation between AAV and pulmonary involvement. Histopathological results: 32 patients with bulbar sclerosis. 19 cases of crescent formation, 14 cases of tubule involvement, 8 cases of focal segmental necrosis, 3 cases of Mesangial hyperplasia and 1 case of skin histopathology showed moderate infiltration of neutrophil around dermis vessels. Reticular, nodular, solid, honeycomb, interlobular septal thickening may be associated with pleural effusion, pleural thickening, lymphadenomegaly, emphysema, trachea dilatation, cavities, and calcification of lymph nodes. The distribution of the lesions was symmetrical, widespread and scattered, mainly in the middle and lower lungs. Conclusion the positive vasculitis of the middle and old women is more common in the middle and old age women. The incidence of lung involvement was 43.9 in most patients with MPO-ANCA positive. ANCA positive associated vasculitis. The clinical manifestations were lack of specificity and easily misdiagnosed as other pulmonary diseases. The lesions were distributed symmetrically, mainly in the middle and lower lungs. The serum HDL decreased significantly in the majority of patients with ANCA positive associated vasculitis.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R593.2

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