甲巯咪唑与抗中性粒细胞胞浆抗体阳性血管炎的关系

目的 研究抗甲状腺药物甲巯咪唑(MMI)与抗中性粒细胞胞浆抗体(ANCA)阳性血管炎的关系.方法 对33例Graves病患儿在服药前及服药后检测血ANCA.同时对我院近年来诊治的2例毒性弥漫性甲状腺肿(Graves病)患儿在服用MMI期间出现ANCA阳性血管炎进行临床病理分析.结果 2例患儿在服用MMI第5～6年出现抗中性粒细胞胞浆抗体阳性血管炎,临床出现血尿、肾功能减退,肾活检示肾血管炎改变,急性肾血管坏死伴新月体形成.经免疫抑制剂等治疗临床缓解;33例Graves病患儿服药前血ANCA均为阴性.有3例患儿分别在服用MMI第2、3个月及2年时出现ANCA阳性,阳性率9%(3/33).临床出现镜下血尿,服药后ANCA阳性率高于服药前(x2=5.3,P<0.05).3例患儿经对症治疗后镜下血尿消失,血ANCA复查转阴性.结论 MMI与ANCA阳性血管炎可能有关,可产生从轻到重的肾脏受累临床表现,采用不同的治疗方法可使症状消失.

Relationship between methimazole and antineutrophil cytoplasmic antibody-positive vasculitis

Objective To study the relationship between methimazole(MMI)and antineutrophil cytoplasmic antibodv(ANCA)-positive vasculitis.Methods Thirty-three cases with Graves'disease were tested for serum ANCA before and after taking MMI.At the same time.clinicopathological data of two patients with Graves'disease who had antineutrophil cytoplasmic antibody-positive vasculitis during treatment with MMl were analyzed.Results Two patients developed antineutrophil cytoplasmic antibody-positive vasculitis during the medication with MMI for 5-6 years:their major clinical manifestations were hematuria and renal failure.Renal biology showed renal vasculitis and vascular necrosis.The disease was relieved after treatment with immunosuppressor.Serum ANCA in the 33 cases Was negative before taking MMI.In 3 cases serum ANCA became positive after taking MMI for 2 mOBths.3 months and 2 years,respectively.The positive rate iS 9%(3/33).The major finding Was microscopic hematuria.ANCA positive rate Was significantly higher after taking MMI than that before taking MMI(X2=5.3,P<0.05).Microscopic hematuria disappeared after general treatment.ConelUsion There may be a relationship between metIlimazole and development of antineutrophil cytoplasmic antibody-positive vasculitis.Renal impairment can occur.The signs and symptoms of the vasculitis can disappear after proper treatment.