摘要
目的探讨肺部受累的抗中性粒细胞胞质抗体相关性血管炎(AAV)患者的临床特征。方法以郑州大学第一附属医院2013年1月至2018年1月收治的196例肺部受累的AAV患者为研究对象,将患者分为显微镜下多血管炎组(MPA组,118例)、肉芽肿性多血管炎组(GPA组,42例)及嗜酸性肉芽肿性多血管炎组(EGPA组,36例)。比较3组患者临床症状、影像表现、实验室指标、治疗及临床缓解情况。结果 MPA组年龄高于其余两组,EGPA组年龄高于GPA组(均P<0.05)。EGPA组乏力和体质量下降者占比低于其余两组,皮疹患者占比高于其余两组,胸闷气喘者占比高于GPA组,GPA组有消化道症状和精神症状者占比低于其余两组,咯血者占比高于其余两组,MPA组肌痛者占比高于其余两组(均P<0.05)。MPA组斑片实变影出现频率低于其余两组,胸膜增厚、纤维条索影、网格状结构出现频率低于其余两组(均P<0.05)。EGPA组白细胞计数低于MPA组,中性粒细胞计数低于其余两组,嗜酸性粒细胞计数高于其余两组,MPA组红细胞计数和血红蛋白水平低于其余两组,血清肌酐水平和红细胞沉降率高于其余两组,差异有统计学意义(均P<0.05)。MPA组抗髓过氧化物酶(MPO)抗体水平高于其余两组,GPA组抗蛋白酶3(PR3)抗体水平高于其余两组(均P<0.05)。主要治疗措施:185例患者接受糖皮质激素治疗,其中113例接受糖皮质激素与环磷酰胺联合治疗,47例接受甲泼尼龙冲击治疗。经过治疗,患者临床症状改善明显,达到临床缓解。结论 MPA患者炎症反应、消耗性及肾功能损害较大,影像以实变影和间质性改变为主,抗MPO抗体水平较高;EGPA患者嗜酸性粒细胞计数较高,皮肤及肺部反应性症状较多见;GPA患者典型表现为肺结节,咯血症状亦较多见,抗PR3抗体水平较高。激素和免疫抑制剂治疗对该病有积极意义。
Objective To explore the clinical features of anti-neutrophil cytoplasmic antibody associated vasculitis(AAV) patients with lung involvement.Methods A total of 196 AAV patients with lung involvement who were admitted to the First Affiliated Hospital of Zhengzhou University from January 2013 to January 2018 were selected as the research subjects. The patients were divided into microscopic polyangiitis group(MPA group, 118 cases), granulomatous with polyangiitis group(GPA group, 42 cases) and eosinophilic granulomatosis with polyangiitis group(EGPA group, 36 cases). The clinical symptoms, imaging performance, laboratory indicators, treatment and clinical remission of the 3 groups were compared.Results Patients in MPA group were older than those in the other two groups, and patients in EGPA group were older than those in GPA group(all P<0.05). In EGPA group, the incidences of fatigue and weight loss were lower than those in the other two groups, and the incidence of rash was higher than that in the other two groups, and the incidences of chest tightness and asthma were higher than that in GPA group(all P<0.05). In GPA group, the incidences of gastrointestinal symptoms and mental symptoms were lower than those in the other two groups, and the incidence of hemoptysis was higher than that in the other two groups(all P<0.05). The incidence of myalgia in MPA group was higher than that in the other two groups(both P<0.05). The incidence of patchy consolidation in MPA group was lower than that in the other two groups(both P<0.05). The incidences of pleural thickening, fibrous stripe shadow, and grid-like structures in MPA group were lower than those in the other two groups(all P<0.05). In EGPA group, leukocyte count was lower than that in MPA group, neutrophil count was lower than that in the other two groups, and eosinophil count was higher than that in the other two groups(all P<0.05). In MPA group, erythrocyte count and hemoglobin level were lower than those in the other two groups, and the serum creatinine level and er
作者
王宁
张国俊
鲍洪杰
WANG Ning;ZHANG Guo-jun;BAO Hong-jie(Department of Respiratory Medicine,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)
出处
《河南医学研究》
CAS
2020年第17期3086-3090,共5页
Henan Medical Research
