34例不明原因发热起病 MPO-ANCA 阳性患者随访分析

目的：初步探讨抗髓过氧化物酶中性粒细胞抗体(MPO-ANCA)阳性在不明原因发热(FUO)患者中的临床意义。方法34例 FUO 伴 MPO-ANCA 阳性患者纳入本研究,记录并分析其临床资料及诊治随访过程的病情变化。结果34例患者中9例考虑与感染和药物相关的 MPO-ANCA 阳性(A 组),其余25例发展为典型的抗中性粒细胞胞质抗体相关性血管炎(AAV)(B 组)。两组间比较,B 组患者红细胞沉降率(P =0．002)、血清铁蛋白(P =0．002)、MPO-ANCA 水平(P =0．001)差异有统计学意义；B 组较 A 组患者伯明翰血管炎活动度评分(BVAS)(P =0．002)及损害器官数(P =0．044)更高,其中,肾功能损害在 B 组更加明显,血肌酐值更高(P =0．005)；B 组中 MPO-ANCA 与 BVAS 间存在显著的相关性( P =0．036), A 组中这种相关性并不明显( P =0．503)。与 B 组相比,A 组患者经积极处理相关病因,AAV病情较轻且容易控制。结论检测 FUO 患者 MPO-ANCA有助于病因诊断,MPO-ANCA 阳性的 FUO 患者多为典型的抗中性粒细胞胞质髓过氧化物酶抗体相关性血管炎(MPO-AAV)的早期表现,少数可能由其他疾病(感染、药物等)诱发,识别后者并积极处理,对确定合理治疗方案非常重要。

A follow up study in 34 patients with MPO-ANCA positive caused by fever of unknown origin

Objective To preliminarily investigate and discuss the clinical significance of positive myeloperoxidase anti-neutrophil cytoplasmic antibodies (MPO-ANCA) in patients with fever of unknown origin(FUO). Methods Thirty-four patients suffered from FUO with MPO-ANCA positive were enrolled in this study. The clinical data and their condition changes during the procedures diagnosis, treatment and follow-ups were recorded and analyzed. Re-sults 9 in 34 patients were deemed as infection-associated MPO-ANCA positive (group A) while the rest 25 pa-tients were developed to typical ANCA-associated vasculitis ( AAV) ( group B). Comparison between the two groups showed that the differences of blood sedimentation (P = 0. 002), serum ferritin(P = 0. 002) and MPO-AN-CA level ( P = 0. 001) in group B had statistical significance. Patient′ s Birmingham vasculitis activity score (BVAS) (P = 0. 002) and number of damaged organs (P = 0. 044) in group B were higher than those of group A, of which the renal dysfunction was even more significant in group B, showing in serum creatinine (P = 0. 005). There was a significant correlation (P = 0. 036) between MPO-ANCA and BVAS in group B while it was not signifi-cant (P = 0. 503) in group A. Compared with group B, patients'AAV conditions seemed mildly and easily to con-trol in group A after positively dealing with relevant etiological factors. Conclusion It will contribute to etiological diagnoses by testing MPO-ANCA in patients with FUO. MPO-ANCA positive in majority of patients with FUO is an early symptom of typical MPO-AAV. Minority may be induced by other diseases (infection and drugs, etc. ). It will be positively treated after confirmation. It is very important to make sure of a reasonable treatment regimen.