嗜酸性肉芽肿性多血管炎患者的临床特征合并感染情况及预后

目的 分析嗜酸性肉芽肿性多血管炎（EGPA）患者的临床特征、治疗过程中合并感染情况及预后。方法 回顾性分析中南大学湘雅医院2010年1月—2019年4月新诊断为EGPA患者的基本资料、临床病理数据，实验室检查、治疗及预后。根据抗中性粒细胞胞质抗体（ANCA）分为阳性和阴性组，以及治疗过程中患者感染发生状况分为感染组和未感染组，比较两组之间的差异。对EGPA患者进行随访，评估患者治疗反应和生存状况。结果 25例患者中临床表现为过敏性鼻炎和哮喘共12例（48.0%），发热和（或）肌肉痛15例（60.0%），神经系统受累17例（68.0%），肾脏受累17例（68.0%）。8例（32.0%）患者ANCA阳性，ANCA阳性组患者发热及肌痛受累率较高，但两组差异无统计学意义（P>0.05）。有15例患者发生感染，以肺部受累最为常见（11例），其中5例肺部感染患者痰培养检出病原体，以细菌多见。与未感染组患者相比，感染组患者确诊EGPA时血浆球蛋白水平较高，差异有统计学意义（P<0.05）。25例EGPA患者中1例未接受免疫抑制剂治疗，1例患者接受单纯免疫抑制剂治疗，7例患者接受单纯糖皮质激素治疗，16例（64%）患者接受糖皮质激素联合免疫抑制剂治疗，其中3例患者同时行血浆置换治疗，1例患者同时予以丙种球蛋白冲击治疗。随访过程中10例失访，余15例患者中位随访时间为35（9~70.5）个月，截至最后一次随访时均存活，6例（24.0%）仍有哮喘症状，12例（48.0%）仍需口服糖皮质激素治疗。结论 EGPA临床表现复杂多样，可累及全身多个器官系统，治疗过程中感染发生率高，病变部位以肺部最为常见，病原体以细菌为主。

Clinical characteristics, infectious complications and prognosis of patients with eosinophilic granulomatosis with polyangiitis

Objective To analyze the clinical characteristics, infectious complications and prognosis of patients with eosinophilic granulomatosis with polyangiitis (EGPA). Methods Basic data, clinicopathological data, laboratory examination, as well as treatment and prognosis of newly diagnosed EGPA patients in Xiangya Hospital of Central South University from January 2010 to April 2019 were retrospectively analyzed. According to positive and negative antineutrophil cytoplasmic antibody (ANCA), well as infection occurrence during treatment process, patients were divided into infection group and non-infection group, differences between two groups were compared. EGPA patients were followed up to evaluate the treatment response and survival status. Results Among 25 patients, 12 cases (48.0%) had allergic rhinitis and asthma, 15 (60.0%) had fever and/or muscle pain, 17 (68.0%) had nervous system involvement, and 17 (68.0%) had renal involvement. ANCA was positive in 8 patients (32.0%),incidence of fever and muscle pain in ANCA positive group was higher, but there was no significant difference between two groups (P>0.05). 15 patients had infection, among which 11 cases were lung involvement. Pathogens were isolated from sputum culture of 5 patients with pulmonary infection, predominantly were bacteria. Compared with patients in non-infection group, patients in infection group had higher levels of serum globulin when EGPA was diagnosed (P<0.05). One EGPA patients didn''t receive immunosuppressive therapy, 1 received simple immunosuppressive therapy, 7 received simple glucocorticoid therapy, and 16 (64%) received glucocorticoid combined immunosuppressive therapy, 3 of whom received plasma exchange and 1 received gamma-globulin therapy. During the follow-up, 10 cases were lost to follow-up, the median follow-up time of the other 15 cases was 35 (9-70.5) months, all of them survived up to the last follow-up, 6 cases (24.0%) still had asthma symptom, and 12 cases (48.0%) still needed oral glucocorticoid therapy. Conclusion Clinical manifestations of EGPA are complex and diverse, involving multiple organs and systems of the whole body, incidence of infection is high during the treatment process, the most common lesion site is lung, bacteria is the main pathogen.