以消化道出血为主要表现的抗中性粒细胞胞质抗体相关性血管炎临床分析

目的 分析以消化道出血为主要表现的抗中性粒细胞胞质抗体(ANCA)相关性血管炎患者的临床特征及预后.方法 查阅我院1987年5月至2007年5月收治的ANCA相关性血管炎合并消化道出血的病例.对患者生存率进行Kaplan-Meier统计分析.结果 ANCA相关性血管炎共170例,其中8例以消化道出血为主要表现,男性和女性各4例;平均年龄(39±20)岁;从疾病出现首发症状到消化道出血平均(8±8)个月;其中韦格纳肉芽肿病合并消化道出血最常见;临床表现最常见为便血(7例,占7/8),远端小肠为最常见受累部位(5例,占5/8);2例患者采用激素冲击治疗,6例采用相当于泼尼松1～2mg·kg-1·d-1激素治疗.1例患者行肠穿孔修补术,2例患者行病变肠段切除术,均是在出现外科情况后手术.3例存活,5例死亡,平均总存活时间为(373±108)d,出现消化道出血后患者平均存活时间为(46±10)d.结论 ANCA相关性血管炎合并消化道出血罕见,预后差.

A clinical analysis of anti-neutrophilic cytoplasmic antibody associated microvasculitis with gastrointestinal tract hemorrhage

Objective To analyze the clinical characteristics and prognosis of ANCA associated microvasculitis patients with gastrointestinal tract hemorrhage. Methods A retrospective analysis was conducted in 8 ANCA associated microvasculitis patients with gastrointestinal tract hemorrhage admitted to our hospital from May 1987 to May 2007. The statistical treatment is Kaplan-Meier. Results This group contained 4 male and 4 female patients. The average age was (39±20) years. The time from the onset of their disease to gastrointestinal bleeding was (8 ±8) months. Wegener's granulomatosis was the most common disease.Hematochezia(7/8 ) was the most common clinical manifestation and the distal small bowel (5/8) was the most common involved site. After the diagnosis was confirmed, methylprednisolone bolus therapy was used in 2 patients and 1～2 mg·kg-1·d-1 prednisone in 6 patients. Surgical operations were performed for 3 patients.However, 5 patients died. The prognosis was poor with the average survival time of (373±108) days. The mean survival time was (46 ±10) days after bleeding. Conclusion ANCA associated microvasculitis with gastrointestinal tract hemorrhage is rare. Early diagnosis and treatment could improve the prognosis.