摘要
目的 分析 16例显微镜下多血管炎 (MPA)患者肺和肺外受累的临床及实验室特点、治疗和预后。方法 对确诊的 16例MPA病人 ,分析其初发表现和实验室资料 ,并在治疗 4～ 6周前后进行FFS、BVAS评分。结果 16例患者年龄 14～ 69岁 ,平均年龄 (5 2 .5± 15 .3 )岁 ,男女比例 10∶6(1.67∶1)。 12例有肺受累患者中初发表现为肺间质病变 (ILD)、咯血、胸腔积液、肺感染的患者分别为 7例、2例、2例、1例 ;ILD患者均有通气及弥散功能障碍 ,3 /7例需通过HRCT诊断 ;有肺受累患者中 11/12例 p ANCA阳性 ,与无肺受累的患者相比 ,其血肌酐明显增高 ;综合治疗后除ANCA外FFS、BVAS等指标均显著改善 ;已知 5 /16例患者 1年内复发。结论 ILD是MPA肺受累早期重要表现之一 ,HRCT、肺功能、BALF中查找含铁血黄素细胞有助于ILD的早期诊断 ;肺受累患者 p -ANCA(+ )多见 ,可能与肾受累程度相关 ;MPA短期治疗反应好 ,易复发 ;
Objective To analyze the clinical and laboratory characters of lung involvement, effect of treatment and prognosis in patients with microscopic polyangiitis(MPA).Methods 16 patients meeting the Chapel Hill criteria for MPA participated in this study. The initial manifestations and laboratory findings of 12 with lung involvement were analyzed. All patients weighted by FFS?BVAS before and after 4～6weeks of comprehensive treatment.Results 10 men and 6 women ,with mean ±SD age of 52.5 ±15.3 years were included in this study. The initial manifestation of 12 patients with lung involvement were ILD (7/12), pulmonary hemorrhage (2/7), hydrothorax (2/7) and pneumonia (1/7). All ILD patients have pulmonary disfunction and HRCT was needed in diagnosing of 3/7 of them. 11/12of patients with lung involvement were with p-ANCA(+).There was no significant difference between patients with and without lung involvement except SCr. FFS, BVAS and laboratory findings were significantly improved after 4～6 weeks of comprehensive treatment except ANCA. 5 patients were known relapse.Conclusion Our study demonstrated that ILD is an common manifestation of early MPA. HRCT,pulmonary test and hemosiderin cells in BALF can be benefit to early diagnosis of ILD of MPA. p-ANCA is more common than c-ANCA in patients with lung involvement. Perhaps lung involvement is associated with renal involvement. MPA can be significantly controlled after comprehensive treatment, but relapse is frequent. Alveolar hemorrhage is one of markers of poor prognosis. \[
出处
《临床内科杂志》
CAS
北大核心
2003年第3期134-136,共3页
Journal of Clinical Internal Medicine
关键词
显微镜
多血管炎
肺损害
Microscopic polyangiitis
Lung involvement
