28例ANCA阳性肺血管炎临床分析

目的总结我科28例ANCA阳性肺血管炎的临床表现,提高对该病认识。方法回顾性分析我科2011-2015年ANCA阳性肺血管炎患者,总结其临床资料、实验室和肺部CT检查表现。结果 28例患者纳入分析,性别比例1∶1.15;平均年龄64.11±13.51岁(36~81岁);大部分患者表现为发热、咳嗽、咳痰;25例患者表现为P-ANCA阳性(89.28%);所有检测ESR的患者均有不同程度升高(21/21),96.30%的患者CRP升高(26/27);17例患者合并有肾受累表现,主要以血尿为主(17/28,60.71%);74.19%的患者有不同程度的贫血,78.57%有中性粒细胞比例升高。肺部CT提示以斑片状渗出影最常见(67.86%),其次为间质病变(28.57%),其他病变包括结节样病变(17.86%),胸腔积液(25.00%),磨玻璃样病变(7.14%)。与单纯肺受累组相比,合并肾受累时实验室检查和肺部影像学改变并无明显差异。结论 ANCA阳性肺血管炎临床和相关检测缺少特异性,诊断上需仔细甄别。

Clinical analysis of 28 patients with positive ANCA pulmonary vasculitis

Objective To summarize the clinical characteristics of positive ANCA pulmonary vasculitis . Methods The clinical data and pulmonary CT chest of patients with positive ANCA pulmonary vasculitis from 2011 to 2015 were retrospectively analyzed .Results The ratio of male to female was 1 ∶1.15, and the mean age was 64.11 ±13.51 years old.Most patients had fever and cough .Of 28 patients, 25 cases were P-ANCA positive (89.28%).All patients given ESR test had high levels (21/21).96.30% patients had high levels of CRP (26/27).The prevalence of renal involvement was 64.29%(18/28), and hematuria was common (17/28, 60.71%). The rate of anaemia was 74.19%.Neutrophil increased in 78.57%patients.CT radiographic manifestations includ-ed diffuse patchy shadow ( 67.86%) , interstitial changes ( 28.57%) , pleural effusion ( 25.00%) , nodule (17.86%) and ground glass attenuation (7.14%).Compared with involved lung only , there was no significant difference in clinical and CT radiographic manifestations in patients with renal involved .Conclusion Pulmonary vasculitis is rare in clinical practice , which should be paid more attention .