摘要
目的总结显微镜下多血管炎(MPA)的临床特点、治疗效果及远期预后,分析MPA的危险因素。方法回顾性分析我院2010年10月至2017年12月的32例MPA患者资料。结果(1)患者平均63.5岁,就诊至确诊的时间为5个月。临床表现均有肺、肾受累。肾脏病理特点为新月体形成为主,12例患者入院即需肾脏替代治疗。肺部表现以发热、咳嗽、咳血等为主。(2)全部接受足量激素(4例冲击治疗)+环磷酰胺治疗,6例血浆置换。治疗过程中,肝功能异常42例,肺部感染19例,类固醇糖尿病或糖耐量异常10例。(3)12例入院即需肾脏替代治疗的患者治疗后有3例短暂脱离透析(平均5.2个月)。(4)随访结束时,20例进入终末期肾病,4例完全缓解,8例死亡。(5)需长期肾脏替代治疗的患者中,年龄较大,确诊前病程较长,确诊时Scr较高,入院需即时透析的比例较高。结论 MPA多发于老年男性,高龄、病程长、Scr高、肺脏受累是MPA预后不良的主要危险因素。应警惕病情严重时积极治疗可能存在的严重并发症风险。
Objective To analyze the clinical features,therapeutic effects,prognosis and the risk factors of microscopic polyangiitis(MPA). Methods The clinical data of 32 cases of hospitalized MPA patients of our Hospital from October 2010 to December 2017 were retrospectively analyzed. Results There were 18 males and14 females,with the mean age of 63.5 years old. The time from consultation to diagnosis was 5 months. All patients had lung and kidney involvement. Renal pathology was characterized by crescentic formation. 12 patients were s involvement showed fever,cough, hemoptysis, etc. All patients received treatments including a sufficient amount of hormone and cyclophosphamide,and 6 cases received plasma exchange. During treatments,there were 42 cases of abnormal liver function,19 cases of pulmonary infection,10 cases of steroid diabetes or impaired glucose tolerance. By the end of follow-up,20 patients required lifelong renal replacement therapy,4 patients had complete remission,8 patients died. Among them,the proportion of patientswhohas older age,or has the longer course of disease before diagnosis,or the higher Scr at the time of diagnosis,or immediate require dialysis after admission is higher in the patients who require lifelong renal replacement therapy. Conclusions MPA is common in old men. The older age,long course of disease,higher Scr,and lung involvement are the main risk factors for poor prognosis of MPA. We should be alert to the risk of serious complications when the condition is serious.
作者
彭用华
王琦
黄宗顺
肖洁
PENG Yonghua;WANG Qi;HUANG Zongshun;XIAO Jie(Department of Nephrology,the First Affiliated Hospital,Guangzhou Medical University,Guangzhou 510000,China)
出处
《实用医学杂志》
CAS
北大核心
2019年第15期2512-2516,共5页
The Journal of Practical Medicine
