抗中性粒细胞浆抗体相关性血管炎肾脏损害的临床和病理分析

目的分析抗中性粒细胞浆抗体(ANCA)相关性血管炎肾脏损害的临床和病理表现。方法随机选取2015年8月至2018年8月我院收治的ANCA相关性血管炎患者68例,分析其临床表现、肾脏病理表现及ANCA表达情况。结果68例患者中,肾脏表现主要为肾脏受累、镜下血尿、血肌酐升高、蛋白尿,分别占总数的100.0%、94.1%、94.1%、80.9%;肾外表现主要为肺,占总数的55.9%;非特异性表现主要为乏力,占总数的69.1%;实验室检查主要为血沉增快,占总数的80.9%。肾脏光镜表现主要为纤维细胞新月体肾炎,占总数的55.9%;免疫荧光表现主要为无免疫复合物,占总数的80.9%。MPA51例,占总数的75.0%,其中P-ANCA定性阳性率、C-ANCA定性阳性率、MPO-ANCA、PR3-ANCA分别为100.0%、7.8%、100.0%、7.8%;WG17例,占总数的25.0%,其中P-ANCA定性阳性率、C-ANCA定性阳性率、MPO-ANCA、PR3-ANCA分别为0.0%、100.0%、0.0%、100.0%。结论分析ANCA相关性血管炎肾脏损害的临床和病理能够将有效依据提供给临床的诊断与治疗工作,值得临床充分重视。

Clinical and pathological analysis of renal damage in antineutrophil cytoplasmic antibody associated vasculitis

Objective To analyze the clinical and pathological manifestations of renal damage in antineutrophil cytoplasmicantibody (ANCA) associated vasculitis. Methods A total of 68 cases of patients with ANCA associated vasculitis were randomly selected from August 2015 to August 2018, and the patients' clinical manifestations, renal pathological manifestations and ANCA expressions were analyzed. Results Among 68 cases of patients, the main renal manifestations were renal involvement, microscopic hematuria, elevated serum creatinine and proteinuria, accounting for 100.0%, 94.1%, 94.1% and 80.9% of the total;extrarenal manifestations were mainly lungs, accounting for 55.9% of the total;non-specific manifestations were mainly fatigue, accounting for 69.1% of the total;laboratory examinations were mainly the increase of ESR, accounting for 80.9% of the total. The main light microcopic manifestations of kidney were fibrocytic crescent nephritis accounting for 55.9% of the total;immunofluorescence manifestations were mainly non-immune complexes, accounting for 80.9% of the total. There were 51 cases of MPA, accounting for 75.0% of the total, the positive rates of P-ANCA, C-ANCA, MPO-ANCA and PR3-ANCA were 100.0%, 7.8%, 100.0% and 7.8%, respectively. There were 17 cases of WG, accounting for 25.0% of the total, the positive rates of P-ANCA, C-ANCA, MPO-ANCA and PR3-ANCA were 0.0%, 100.0%, 0.0% and 100.0% respectively. Conclusion Analysis of the clinical and pathological features of renal damage in ANCA associated vasculitis can provide effective evidence for clinical diagnosis and treatment, which deserves full attention in clinic.