摘要
目的通过对合并肢端坏疽的结节性多动脉炎（PAN）患者的临床资料进行分析，了解其特点，提高临床医生的认识水平。方法收集北京协和医院1986年11月至2016年10月住院治疗的PAN患者的临床和实验室资料，对合并肢端坏疽的患者进行总结，并按照1∶2的比例随机选取同时期无肢端坏疽的PAN患者进行比较，包括一般情况，系统受累，实验室及其他辅助检查结果，激素冲击治疗情况的对比。采用SPSS 19.0统计软件包进行分析，行t检验，Mann-Whitney检验，χ^2检验。结果1986年11月至2016年10月住院治疗的PAN患者共204例，合并肢端坏疽的22例。合并肢端坏疽的患者中，男∶女4.5∶1，平均年龄（43±19）岁，从起病到出现坏疽的中位时间3.5个月，时间1周至20年。其中单纯手指坏疽7例（32%），单纯足趾坏疽8例（36%），同时手足坏疽7例（32%）。以肢体血管受累表现明显，其中胫后动脉受累15例（68%），胫前动脉受累12例（55%），桡动脉受累10例（45%），尺动脉受累7例（32%），腓动脉受累5例（23%），股浅动脉受累5例（23%），足背动脉受累4例（18%），腘动脉受累3例（14%），骨间前动脉受累1例（5%）。有肢端坏疽的PAN患者更容易出现关节炎/关节痛（45%和2%，χ^2=16.71，P=0.00），新发高血压（41%和7%，χ^2=9.28，P〈0.01），肠道出血/穿孔（41%和14%，χ^2=6.21，P=0.01），更易伴有嗜酸性粒细胞升高（55%和7%，χ^2=19.02，P〈0.01），肢体动脉（91%和27%，χ^2=23.78，P〈0.01）及头颈部动脉受累（41%和18%，χ^2=3.96，P=0.05），动/静脉血栓形成（27%和2%，χ^2=7.21，P=0.007），更多患者应用激素冲击治疗[16例（73%）与6例（14%），χ^2=23.05，P〈0.01]，差异均有统计学意义（P〈0.05）。结论有肢端坏疽的PAN患者更多合并嗜酸性粒细胞增多，可能与血液高黏滞状态有关，更容易出现其他脏器的缺血表现，需要更积极的治疗。
ObjectiveTo evaluate the clinical characterisitics of polyarteritis nodosa（PAN） patients with acromelic gangrene, and to improve the understanding of this disease by clinicians.MethodsThe clin-ical and laboratory data of PAN patients with acromelic gangrene admitted to Peking Union Medical College Hospital（PUMCH） between November 1986 to October 2016 were collected and summarized. According to the ratio of 1∶2, PAN patients without acromelic gangrene during the same period were randomly selected and compared with patients with acromelic gangrene. The comparison of the demographic data, system involvement, laboratory and other auxiliary examination results, the treatment were included in this study. All data were an-alyzed by SPSS 19.0 statistical software. T test, Mann Whitney U test, χ^2 test were used for statistical analyses.ResultsAmong 204 PAN patients admitted to PUMCH during this period, 22 cases were complicated with gangrenes. In PAN patients with gangrenes,-male/female ratio was 4.5/1, the mean age was （43±19） years, and the disease duration （from onset of disease to gangrene） was 3.5 months （ranged from 1 week to 20 years）. Simple finger gangrenes occurred in 7 cases（32%）, simple toe gangrenes in 8 cases （36%）, both gangrenes in 7 cases （32%）. In the involvements of limb arteries, 15 cases（68%） were posterior tibial artery involvement, 12 cases（55%） were anterior tibial artery involvement, 10 cases（45%） were radial artery involvement, 7 cases （32%） were ulnar artery involvement, 5 cases （23%） were peroneal artery involvement, 5 cases （23%） were superficial femoral artery involvement, 4 cases（18%） were dorsal foot artery involvement, 3 cases （14%） were popliteal artery involvement,1 case （5%） was anterior interosseous artery involvement. There were significant difference in PAN patients with and without acromelic gangrene as patients with acromelic gangrene were more prone to arthritis/pain （45% vs 2%; χ^2=16.71, P〈0.01）, new-onset hypertension （41% vs 7%; χ^2=9.28, P〈0.01）, intestinal bleeding/perforation （41% vs 14%; χ^2=6.21, P=0.01）, increased eosinophils （55% vs 7%; χ^2=19.02, P〈0.01）, artery （91% vs 27%; χ^2=23.78, P〈0.01） involvement in extremities, head and neck （41% vs 18%; χ^2=3.96, P=0.05）, arteriovenous thrombosis （27% vs 2%; χ^2=7.21, P=0.007）, glucocorticoid pulse therapy （73% vs 14%; χ^2=23.05, P〈0.01）.ConclusionPAN patients with acromelic gangrene have significant increase of eosinophils and widespread internal organ ischemia. Aggressive treatment should be taken in these patients.
作者
李淼
孙玉兰
徐东
李菁
田新平
Li Miao;Sun Yulan;Xu Dong;Li Jing;Tian Xinping(Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences ＆ Peking Union Medical College, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing 100730, China)
出处
《中华风湿病学杂志》
CAS
CSCD
北大核心
2018年第4期246-250,共5页
Chinese Journal of Rheumatology
关键词
多动脉炎
结节性
坏疽
临床特点
Polyarteritis nodosa
Gangrene
Clinical characteristics
