合并肾损害的抗中性粒细胞胞浆抗体相关性血管炎患者临床资料分析

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Abstract Objective To investigate the clinical characteristics and relevant factors of prognosis in patients with anti-neutrophil cytoplasmic antibodies (ANCA) associated with vasculitis (AAV). Methods The clinical data of 65 patients of kidney damage with AAV in Department of Nephrology, the Affiliated Hospital of Xuzhou Medical University from August 2013 to August 2017 were retrospectively analyzed, including the general characteristics, systems involvement, auxiliary examinations and treatment outcomes. For patients with complete follow-up outcomes (54 cases), they were divided into the poor prognosis group (24 cases) and the good prognosis group (30 cases) according to the different prognosis. The clinical characteristics and the auxiliary examinations were compared between the two groups. Results The average age of the patients was (65±12) years, the medium time of diagnosis was 1 (0.5-4.0) months. Multiple systems were damaged, especially in urinary system (65 cases) and respiratory system (45 cases). CT scans showed that interstitial change was common, with 42 cases (42/65, 64.6%). The blood test showed that anemia was 57 cases (57/65, 87.7%). The C-reactive protein and the blood sedimentation were higher, with 57 cases (87.7%) and 58 cases (89.2%) respectively. ANCA was mainly MPO positive (60 cases, 92.3%). Seven routine renal biopsies were performed, 4 were crescent glomerulonephritis and 3 were immunofluorescence negative. Fifity-five cases were treated with glucocorticoids and 47 cases treated with glucocorticoids combined with cyclophosphamide. There were 54 patients with complete follow-up data and showed that 30 cases were remission, 16 were treated with maintenance hemodialysis and 8 were died. The scores of birmingham vasculitis activity scores (BVAS) and the serum creatinine in the poor prognosis group were all higher than those of good prognosis group, the hemoglobin was lower than that of good prognosis group, the incidences of systems damage and the lung interstitial change were all higher than those of good prognosis group, with statistically significant differences (P ＜ 0.05). Conclusion The AAV occurs predominantly in the elderly. Multi-system are involved with a variety of clinical manifestations, particularly in urinary system and respiratory system. It seems that higher BVAS score, lower hemoglobin level, heavier damage of the major organs and seriously lung interstitial change are associated with higher risk of the poor prognosis.

Key words： Vasculitis Anti-neutrophil cytoplasmic antibodies Kidney damage Prognosis

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	LI Qianqian LI Shengkai▲

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LI Qianqian LI Shengkai▲. Clinical analysis of anti-neutrophil cytoplasmic antibodies associated with vasculitis in patients of kidney damage[J]. 中国医药导报, 2018, 15(12): 48-52.

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http://www.yiyaodaobao.com.cn/EN/ OR http://www.yiyaodaobao.com.cn/EN/Y2018/V15/I12/48

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