丙硫氧嘧啶引起抗中性粒细胞胞浆抗体相关小血管炎6例临床分析

目的：提高临床对丙硫氧嘧啶（PTU）引起抗中性粒细胞胞浆抗体（ANCA）相关小血管炎的认识。方法：分析近年诊治的6例PTU引起ANCA相关小血管炎患者的临床表现、实验室及病理检查、治疗及随访情况。结果：6例患者服用PTU至出现小血管炎症状的时间不等，2月-7年，小血管炎表现也可在PTU停药后出现，临床表现不一，轻者仅皮肤、关节、肌肉受累，重者可出现重度贫血、肺出血、肾受累，抗MPO-ANCA均阳性。停用PTU及激素、免疫抑制剂治疗后病情好转，ANCA滴度下降或转阴。结论：PTU可引起ANCA相关小血管炎，部分可引起肺出血及肾损害，临床应予重视，及时停用PTU及相应治疗大多预后较好。

Propythiouracil-induced antineutrophil cytoplasmic antibody-associated vasculitis: analysis of 6 cases

Objective:To improve the knowledge on propythiouracil(PTU)-induced antineutrophil cytoplasmic antibody(ANCA)-associated vasculitis.Methods:6 cases of PTU-induced ANCA-associated vasculitis were analyzed on clinical manifestation,laboratory and biopsy findings,therapy and prognosis.Results:All patients with Grave's disease had been treated with PTU from 2 months to 7 years suffered from ANCA-associated vasculitis, which can also appear after withdrawal of PTU. Clinical manifestations are different with only skin, joint, muscle involvements on mild cases or lung, renal and hematological involvement on severe cases. Sera from all patients were anti MPO-ANCA positive. All patients responded to withdrawal of PTU and administration of prednisone and immuno-suppressants well with ANCA declined or turned to negative.Conclusion:PTU can induce ANCA-associated vasculitis in the part of which lung and kidney can be seriously involved. Early withdrawal of PTU and administration of immunosuppressive agents might improve the prognosis.