显微镜下型多血管炎肾损害23例临床病理分析

目的了解显微镜下型多血管炎（MPA）肾损害患者临床和病理特征.方法对23例MPA的临床、病理改变进行分析归纳,并将抗中性粒细胞胞质抗体（ANCA）（＋）和ANCA（-）的MPA患者进行比较.结果MPA患者多见于老年男性,肾外表现除发热、体重下降、纳差非特异症状外,还多见肺损害、浆膜炎、关节炎、肌痛等.65.2%的患者ANCA（＋）.肾脏表现均有血尿、蛋白尿,表现为不同程度的肾功能损害.病理上显示23例患者均有肾小球新月体形成,新月体以纤维性为主,半数以上患者见袢坏死及间质血管炎.结论MPA患者除肾脏功能损害外,常伴肾外表现,而ANCA（＋）与ANCA（-）组在临床表现、肾脏病理方面差异有统计学意义.

The clinical pathological analysis of 23 patients with renal damage caused by microscopic polyangiitis

Objective To study the clinical features and pathology of renal damage in patients with MPA. Method The clinical pathological changes of 23 MPA patients were analyzed and the patients with positive ANCA were compared with those with negative ANCA. Results Most MPA patients were senile and male with the symptoms of lung damage, pleuritis, arthritis and myalgia as well as extrarenal symptoms such as fever, weight-loss, and anorexia. 65.2% of the patients were ANCA (+). Symptoms of renal function damage were hematuria and proteinuria, which could be found in all the patients. Different degree of renal damage could be detected. Glomerular cresent formation, which were mostly fibrous, could be found in all of the 23 patients. Half of the patients have tuft necrosis and interstitial vessel vasculitis. Conclusion MPA patients often have extrarenal symptoms besides renal function damage. Patients with positive ANCA differs from patients with negative ANCA in both clinical manifestation and kidney pathology.