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目的通过分析显微镜下多血管炎(MPA)肾损害的临床表现、诊断及预后,旨在提高对该病的认识水平。方法回顾性分析该院2011年1月至2016年7月收治的39例MPA合并肾损害患者的临床资料,并将患者按起病缓急程度分为急进性肾炎综合征组和慢性肾炎综合征组,并对两组的临床资料进行比较。结果 39例患者中男21例、女18例,平均年龄(61.69±10.32)岁;其中合并肺部表现10例、合并周围神经病变6例、合并发热20例、合并贫血36例、合并皮肤血管炎2例;肾损害表现为少尿22例,肾性高血压29例,尿常规中镜下血尿39例,24h尿蛋白定量小于3.5g 25例,大于或等于3.5g 14例,血肌酐正常1例,小于500μmol/L 14例,大于或等于500μmol/L 24例;35例抗中性粒细胞胞质抗体(PANCA-MPO)阳性、3例CANCA-PR3阳性、1例PANCA和CANCA均阴性;急进性肾炎综合征组合并肺损害明显高于慢性肾炎综合征组(P=0.035),且病死率明显高于慢性肾炎综合征组(P=0.001)。结论 MPA好发于老年人,以肺脏和肾脏受累为主,以MPO-PANCA阳性多见,表现为急进性肾炎的患者易合并肺损害、引起死亡。
Objective To analyze the clinical manifestations, diagnosis and prognosis of microscopic polyangitis (MPA) with renal impairment aimed at improving the level of awareness of the disease. Methods The clinical data of 39 patients with MPA complicated with renal impairment who were admitted to our hospital from January 2011 to July 2016 were retrospectively analyzed. According to the degree of onset, the patients were divided into two groups: acute nephritic syndrome group and chronic nephritic syndrome group , And the clinical data of two groups were compared. Results Among the 39 patients, 21 were males and 18 were females, with a mean age of (61.69 ± 10.32) years. Among them, 10 were complicated with pulmonary manifestations, 6 were complicated with peripheral neuropathy, 20 were complicated with fever, 36 were complicated with anemia, Inflammation in 2 cases; renal damage manifested as oliguria in 22 cases, renal hypertension in 29 cases, urinary routine endoscopic hematuria in 39 cases, 24h urine protein less than 3.5g in 25 cases, greater than or equal to 3.5g in 14 cases, normal serum creatinine 1 case, less than 500μmol / L in 14 cases and greater than or equal to 500μmol / L in 24 cases; 35 cases were positive for antineutrophil cytoplasmic antibody (PANCA-MPO), 3 cases were positive for CANCA-PR3 and 1 case was negative for PANCA and CANCA The incidence of acute nephritis syndrome combined with lung injury was significantly higher than that of chronic nephritic syndrome group (P = 0.035), and the mortality was significantly higher than that of chronic nephritic syndrome group (P = 0.001). Conclusions MPA occurs predominantly in the elderly and mainly affects the lungs and kidneys. MPO-PANCA is more common in patients with acute nephritis. It may lead to lung damage and cause death.