MPO-AAV患者临床特点及其肺部受累预后危险因素分析

发布时间：2018-04-04 22:26

  本文选题：髓过氧化物酶阳性的抗中性粒细胞胞浆抗体相关性血管炎　切入点：呼吸衰竭　出处：《复旦学报(医学版)》2016年01期

【摘要】：目的分析髓过氧化物酶阳性的抗中性粒细胞胞浆抗体相关性血管炎(myeloperoxidase antineutrophil cytoplasmic antibody-associated vasculitis,MPO-AAV)患者临床特点并探讨肺部受累患者呼吸衰竭、肺部感染和死亡的危险因素。方法收集复旦大学附属中山医院2005年2月至2013年12月初诊入院的MPO-AAV患者基线时临床资料,截至2014年8月或死亡,应用Logistic多因素回归分析肺部受累患者不同预后的独立危险因素。结果共纳入98例确诊的MPO-AAV患者,早期系统型13例,全身型50例,重型28例,难治型7例。呼吸系统以咳嗽咳痰、胸闷气促为主要表现;胸部X线和高分辨CT(high resolution computed tomography,HRCT)示以渗出(36例)、肺间质改变(35例)常见;肺活检示8例肺组织病理学见肺泡间隔破坏、慢性炎性细胞浸润。糖皮质激素治疗92例,免疫抑制剂治疗79例,两种球蛋白治疗19例,免疫吸附5例。治疗后改善者71例,复发者17例。发生急性呼吸衰竭者16例,死亡9例,肺部感染者35例;分别以急性呼吸衰竭、死亡和肺部感染为终点,Logistic回归分析肺部受累患者临床资料发现:肺部感染、肺间质病变、Scr500μmol/L以及ALB30 g/L是急性呼吸衰竭的危险因素;发病年龄≥65岁、急性呼吸衰竭是患者死亡的危险因素;急性呼吸衰竭是患者肺部感染的危险因素。结论 MPO-AAV患者多有肺部受累,同时伴有全身及血液、肾脏等其他系统受累的异常表现。肺部感染是MPO-AAV肺部受累患者发生急性呼吸衰竭的主要诱发因素,且二者相互促进增加患者死亡风险;发病年龄65岁是呼吸衰竭患者死亡的危险因素。
[Abstract]:Objective to analyze the clinical features of myeloperoxidase antineutrophil cytoplasmic antibody-associated vasculitis (MPO-AAVV) patients with myeloperoxidase positive anti-neutrophil cytoplasmic antibody (ACA) and to investigate the risk factors of respiratory failure, pulmonary infection and death in patients with pulmonary involvement.Methods the clinical data of MPO-AAV patients who were hospitalized from February 2005 to December 2013 in Zhongshan Hospital affiliated to Fudan University were collected. By Aug. 2014 or death, Logistic multivariate regression analysis was used to analyze the independent risk factors for different prognosis of patients with pulmonary involvement.Results 98 cases of MPO-AAV were included, including early systemic type (13 cases), systemic type (50 cases), severe type (28 cases) and refractory type (7 cases).Chronic inflammatory cell infiltration.92 cases were treated with glucocorticoid, 79 cases were treated with immunosuppressant, 19 cases were treated with two kinds of globulin, and 5 cases were treated with immunosorbent.There were 71 cases of improvement and 17 cases of recurrence after treatment.There were 16 cases of acute respiratory failure, 9 cases of death and 35 cases of pulmonary infection.Scr500 渭 mol/L and ALB30 g / L were risk factors of acute respiratory failure, age 鈮，

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