| 摘要: |
| 目的 探讨肺部受损的髓过氧化物酶（MPO）阳性抗中性粒细胞胞质抗体（ANCA）相关性血管炎（AAV）患者的临床及肺部影像学特征。方法 回顾性分析2014年1月至2020年12月在中国人民解放军联勤保障部队第九六〇医院肾内科就诊的MPO-ANCA阳性且确诊为AAV的59例患者的一般资料、实验室检查结果、肺部影像学资料和合并症。根据患者尿常规、血肌酐及估算的肾小球滤过率（eGFR）等结果将患者分为单纯肺损伤组和肺肾合并损伤组，对两组患者的上述资料进行比较分析。结果 纳入的59例患者中，男27例、女32例，发病年龄为24～93（61.8±15.6）岁。单纯肺损伤组13例，肺肾合并损伤组46例，两组的发病年龄及性别差异均无统计学意义（P均＞0.05）。与单纯肺损伤组相比，肺肾合并损伤组患者血红蛋白［（85.13±23.79） g/L vs （116.38±23.99）g/L]、白蛋白［（27.55±4.68） g/L vs （34.75±5.31） g/L]水平降低，红细胞沉降率［（73.60±35.04） mm/1 h vs（57.77±34.56） mm/1 h]、CRP[28.15（5.08，103.00） mg/L vs 14.30（5.55，58.70） mg/L]水平增高，体重下降患者的占比[4.3%（2/46） vs 30.8%（4/13）]降低，有恶心纳差/乏力症状的患者占比[37.0%（17/46） vs 7.7%（1/13）]增高，高血压患者占比[87.0%（40/46） vs 46.2%（6/13）]增高，差异均有统计学意义（P均＜0.05）。59例患者均行胸部CT检查，影像学改变以网格样改变、斑片实变影及胸膜增厚多见，但这些特征性改变在两组患者间差异无统计学意义（P均＞0.05）。结论 MPO-ANCA阳性的AAV患者肺部影像学改变多样，但单纯肺损伤组与肺肾合并损伤组的肺部影像学改变无特异性。肺肾合并损伤组患者合并高血压的比例高于单纯肺损伤组，且容易出现严重的贫血及低蛋白血症，提示预后不良。 |
| 关键词: 抗中性粒细胞胞质抗体相关性血管炎 髓过氧化物酶 肾损伤 间质性肺疾病 |
| DOI：10.16781/j.CN31-2187/R.20220626 |
| 投稿时间：2022-07-26修订日期：2022-11-14 |
| 基金项目:山东省医药卫生科技发展计划项目（202203051068）. |
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| Myeloperoxidase-positive antineutrophil cytoplasmic antibody-associated vasculitis with lung involvement: clinical characteristics of 59 cases |
| SHI Shumei1,WANG Ying2,WANG Yanxia1,WEI Ping1,XU Chenggang3* |
(1. Department of Nephropathy, No. 960 Hospital of Joint Logistics Support Force of PLA, Jinan, 250031, Shandong, China;
2. Department of Respiratory, No. 960 Hospital of Joint Logistics Support Force of PLA, Jinan, 250031, Shandong, China;
3. Department of Nephropathy, The Third Affiliated Hospital of Naval Medical University (Second Military Medical University), Shanghai 200082, China
*Corresponding author) |
| Abstract: |
| Objective To investigate the clinical and lung imaging features of patients with myeloperoxidase (MPO)- positive antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) with lung involvement. Methods The general data, laboratory examinations, lung imaging changes, and complications of 59 patients with MPO-ANCA positive and diagnosed as AAV in the Department of Nephrology of No. 960 Hospital of Joint Logistics Support Force of PLA from Jan. 2014 to Dec. 2020 were retrospectively analyzed. According to the results of urine routine, serum creatinine, and estimated glomerular filtration rate, the patients were divided into simple lung injury group and lung and kidney combined injury group, and the above data of the 2 groups were compared and analyzed. Results Among the 59 patients, there were 27 males and 32 females, with an onset age of 24-93 (61.8±15.6) years old. There were 13 patients in the simple lung injury group and 46 in the lung and kidney combined injury group. There were no significant differences in age or gender of onset between the 2 groups (both P＞0.05). Compared with the simple lung injury group, the levels of hemoglobin ([85.13±23.79］g/L vs[116.38±23.99］g/L), albumin ([27.55±4.68］g/L vs[34.75±5.31］g/L), and the proportion of weight loss (4.3% [2/46］vs 30.8%[4/13］) in the lung and kidney combined injury group were significantly decreased, while the erythrocyte sedimentation rate ([73.60±35.04］mm/1 h vs[57.77±34.56］mm/1 h), C reactive protein (28.15[5.08, 103.00］mg/L vs 14.30[5.55, 58.70］mg/L), and the proportions of nausea/fatigue (37.0%[17/46］vs 7.7%[1/13］) and hypertension (87.0%[40/46］ vs 46.2%[6/13］) were significantly increased (all P＜0.05). All the 59 patients underwent chest computed tomography, and the most common imaging changes were grid changes, patch consolidation, and pleural thickening, but these characteristic changes had no significant differences between the 2 groups (all P＞0.05). Conclusion The lung imaging changes in MPOANCA positive AAV patients are varied, but the changes in the 2 groups are not specific. The lung and kidney combined injury group have more patients with hypertension and are prone to developing severe anemia and hypoproteinemia, suggesting a poor prognosis. |
| Key words: antineutrophil cytoplasmic antibody-associated vasculitis myeloperoxidase renal injury interstitial lung diseases |
