59例肺部受损的MPO阳性ANCA相关性血管炎的临床特征分析

目的 分析肺部受累的MPO阳性ANCA相关性血管炎患者的临床及肺部影像学特征。方法 分析2014年1月至2020年12月在联勤保障部队第九六〇医院肾内科就诊的MPO-ANCA阳性且确诊为ANCA相关性血管炎（AAV）的59例患者的临床特征、辅助检查、肺部影像学改变。根据患者尿常规、血肌酐（CRE）及肾小球滤过率（eGFR）等数值分为两组：单纯肺损害组及肺肾合并损害组，并且对两组患者的上述资料进行分析。结果 1.入选的59例患者中，单纯肺损伤组13例（男/女：6/7），平均年龄60±17.63岁；肺肾合并损伤组46例（男/女：21/25），平均年龄62.28±15.12岁。两组的发病年龄及性别差异均无统计学意义（P>0.05）。2.单纯肺损伤组患者血红蛋白（HGB）、白蛋白（ALB）、肾功能（CRE、BUN）、血沉（ESR）、C反应蛋白（CRP）结果分别为：116.38±23.99、34.75±5.31、62.69±14.04、4.02±1.63、57.77±34.56、14.3(5.55,58.70)，肺肾合并损伤组上述结果分别为：85.13±23.79、27.55±4.68、402.07±103.90、19.14±11.50、73.60±35.04、28.15(5.08,103.0)，两组数据差异有统计学意义（P<0.05）。单纯肺损伤组患者HGB、ALB水平明显高于后者，而ESR、CRP水平低于后者。3.两组比较，肺肾合并损伤组中高血压患者占比（86.96%）明显高于单纯肺损伤组（46.15%），两组差异有统计学意义（P<0.05），其余合并症在两组患者中的占比差异无统计学意义。4.两组患者临床表现方面，单纯肺损伤组患者体重下降（30.77%）比后者（4.34%）占比高，肺肾合并损伤组恶心纳差/乏力症状（39.96%）较前者（7.69%）占比高，差异均有统计学意义（P<0.05）。5.对所有患者的影像学改变进行分类，影像学改变以网格样改变、斑片实变影及胸膜增厚多见。肺肾损伤组患者多见于斑片实变影，但两组患者不同的影像学改变差异无统计学意义（P>0.05） 结论 1.MPO阳性的AAV患者肺部影像学改变多样，但两组改变无特异性；2.两组患者临床表现多样，肺肾损伤组中，高血压患者占比明显高于单纯肺损伤组；3.肺肾合并损伤组肾功能损害较重且容易出现严重的贫血及低蛋白血症，提示预后不良，需及时治疗。

Analysis of clinical characteristics of 59 myeloperoxidase-ANCA-associated vasculitis patients with Lung Involvement

Objective To analyze the clinical and pulmonary imaging features of MPO-positive ANCA-associated vasculitis with lung involvement. Methods The clinical features, auxiliary examination and pulmonary imaging changes of 59 patients with MPO-ANCA positive and diagnosed as AAV in the Department of Nephrology of the United Logistics Force 960 Hospital from January 2014 to December 2020 were analyzed. According to urine routine, serum creatinine (CRE) and glomerular filtration rate (eGFR), the patients were divided into two groups: simple lung injury group and combined injury of lung and kidney group. Results Among the 59 patients, there were 13 patients with simple lung injury (male / female: 6 stroke 7), with an average age of 60±17.63 years old, and 46 patients with combined injury of lung and kidney group (male / female: 21 × 25), with an average age of 62.28 ±15.12 years. There was no significant difference in age and sex of onset between the two groups (P > 0.05). The results of hemoglobin (HGB), albumin (ALB), renal function (CRE, BUN), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) in patients with simple lung injury were 116.38 ±23.99,34.75 ±5.31,62.69 ±14.04,4.02 ±1.63,57.77 ±34.56,14.3 (5.55, 58.70). The above results in the combined injury of lung and kidney group were 85.13 ±23.79,27.55 ±4.68,402.07 ±103.90, 19.14 ±11.50,73.60 ±35.04,28.15 (5.08, 103.0). The levels of HGB and ALB in patients with simple lung injury were significantly higher than those in the latter, while the levels of ESR and CRP were lower than those in the latter. Compared with the two groups, the proportion of patients with hypertension in the combined injury of lung and kidney group (86.96%) was significantly higher than that in the simple lung injury group (46.15%), and there was significant difference between the two groups (P<0.05). There was no significant difference in the proportion of other complications between the two groups. In terms of clinical manifestations of the two groups, the proportion of weight loss in the simple lung injury group (30.77%) was higher than that in the latter (4.34%), and the proportion of nausea/fatigue in the combined injury of lung and kidney group (39.96%) was higher than that in the former (7.69%). The difference was statistically significant (P<0.05). The imaging changes of all patients were classified, and the most common imaging changes were grid changes, patch consolidation and pleural thickening. Patchy consolidation was common in patients with combined injury of lung and kidney group, but there was no significant difference in imaging changes between the two groups (P>0.05). Conclusion The lung imaging changes in MPO positive AAV patients were varied, but the changes in the two groups were not specific. The clinical manifestations of the two groups were diverse. the proportion of patients with hypertension in the combined injury of lung and kidney group was significantly higher than that in the simple lung injury group. The patients with combined injury of lung and kidney group had severe renal function damage and were prone to severe anemia and hypoproteinemia, suggesting that the prognosis was poor and should be treated in time.