發(fā)布時間：2018-03-03 00:26

  本文選題：抗中性粒細胞胞質(zhì)抗體　切入點：血管炎　出處：《廣西醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:分析82例初診的ANCA陽性相關(guān)性血管炎臨床特點,旨在提高對該病的認識。方法:回顧性分析廣西醫(yī)科大學(xué)第一附屬醫(yī)院2015年1月至2016年12月初診的82例符合ANCA陽性相關(guān)性血管炎診斷患者的病歷資料,如基本資料(如年齡、性別、入院診斷、首診科室等)、臨床癥狀及輔助檢查資料。結(jié)果:82例患者中男28例,女54例,男女之比為1:1.926,平均年齡為58.45±15.77歲,平均首診時間為3個月,其臨床癥狀不具有特異性,常常表現(xiàn)為腎臟受累(如血尿、蛋白尿、肌酐升高)、全身癥狀(如納差、乏力、發(fā)熱、消瘦)以及呼吸道癥狀(如咳嗽、咳痰、咯血)等,大約89%患者被誤診為其他疾病,如腎功能不全、肺炎等。實驗室檢查結(jié)果:82例患者中MPO-ANCA陽性74例,PR3-ANCA陽性8例,兩者比9.25:1,平均抗體滴度為1:50.45;除此之外白細胞升高34例(41.46%),中性粒細胞百分比升高44例(53.55%),血紅蛋白降低78例(95.12%),ESR升高79例(96.34%),CRP升高76例(92.68%),肌酐升高59例(71.95%)。大多數(shù)患者(81.58%)血清高密度脂蛋白明顯下降�？人�、咳痰、咯血、超敏C反應(yīng)蛋白升高、血沉升高在AAV肺臟受累組與非肺臟受累組間的差異具有統(tǒng)計學(xué)意義(P0.05)。Logistic多因素分析示:超敏C反應(yīng)蛋白升高(OR=1.009,95%Cl 0.999~1.018,P=0.069),血沉升高(OR=1.010,95%Cl 0.996~1.025,P=0.162),超敏C反應(yīng)蛋白升高和血沉的升高與AAV是否肺臟受累無相關(guān)性。組織病理學(xué)結(jié)果:球性硬化32例,新月體形成19例,小管受累14例,局灶節(jié)段壞死8例,系膜增生3例;1例皮膚組織病理示真皮血管周中等量中性白細胞浸潤。胸部CT結(jié)果:以間質(zhì)性改變?yōu)橹?以磨玻璃影、網(wǎng)格狀、結(jié)節(jié)影、實變影、蜂窩狀、小葉間隔增厚改變?yōu)槎嘁?可伴隨有胸腔積液、胸膜增厚、淋巴結(jié)腫大、肺氣腫、氣管擴張、空洞、淋巴結(jié)鈣化等表現(xiàn),病灶的分布特點:對稱、廣泛、散在、以中下肺為主。結(jié)論:ANCA陽性相關(guān)性血管炎好發(fā)于中老年女性,大多數(shù)患者MPO-ANCA陽性。ANCA陽性相關(guān)性血管炎肺臟的受累率為43.9%,臨床表現(xiàn)缺乏特異性,易被誤診其他肺部疾病。胸部CT常表現(xiàn)為兩肺形態(tài)各異、密度不均、邊界不規(guī)則的滲出影,病灶呈對稱分布,主要集中在中下肺。絕大多數(shù)ANCA陽性相關(guān)性血管炎患者血清高密度脂蛋白顯著下降。
[Abstract]:Objective: to analyze the clinical characteristics of 82 cases of ANCA positive associated vasculitis. Methods: 82 cases of ANCA positive associated vasculitis diagnosed from January 2015 to December 2016 in the first affiliated Hospital of Guangxi Medical University were analyzed retrospectively. Results among 82 patients, 28 were male and 54 were female, the ratio of male to female was 1: 1.926, the average age was 58.45 鹵15.77 years, and the average first visit time was 3 months. Its clinical symptoms are not specific and are often characterized by kidney involvement (e.g. hematuria, proteinuria, creatinine elevation), systemic symptoms (such as anorexia, fatigue, fever, emaciation) and respiratory symptoms such as cough, expectoration, hemoptysis, etc. About 89% patients were misdiagnosed as other diseases, such as renal insufficiency, pneumonia, etc. Laboratory tests showed that 74 of 82 patients were MPO-ANCA positive and 8 were positive for PR3-ANCA. The ratio is 9.25: 1, the average titer of antibody is 1: 50.45; in addition, there are 34 cases of leukocytosis and 41.46% increase, 44 cases of increased percentage of neutrophils, 44 cases of increase of neutrophil percentage and 44 cases of increase of neutrophil percentage, 78 cases of hemoglobin decrease and 78 cases of decrease of hemoglobin in 78 cases. There are 79 cases of elevated CRP in 76 cases and creatinine in 59 cases (71.95%). Most patients have 81.58% of blood. Clear high density lipoprotein decreased markedly. Cough, Expectoration, hemoptysis, hypersensitive C-reactive protein increase, The difference of ESR between AAV lung involvement group and non-pulmonary involvement group was statistically significant (P 0.05). Logistic multivariate analysis showed that: hypersensitive C-reactive protein increased 1.009 ~ 95Cl 0.999 ~ 1.018L P0.069, ESR was 1.01095 Cl 0.9961.025P0. 162, hypersensitive C-reactive protein increased and erythrocyte sedimentation rate increased and erythrocyte sedimentation rate increased. There was no correlation between AAV and pulmonary involvement. Histopathological results: 32 patients with bulbar sclerosis. 19 cases of crescent formation, 14 cases of tubule involvement, 8 cases of focal segmental necrosis, 3 cases of Mesangial hyperplasia and 1 case of skin histopathology showed moderate infiltration of neutrophil around dermis vessels. Reticular, nodular, solid, honeycomb, interlobular septal thickening may be associated with pleural effusion, pleural thickening, lymphadenomegaly, emphysema, trachea dilatation, cavities, and calcification of lymph nodes. The distribution of the lesions was symmetrical, widespread and scattered, mainly in the middle and lower lungs. Conclusion the positive vasculitis of the middle and old women is more common in the middle and old age women. The incidence of lung involvement was 43.9 in most patients with MPO-ANCA positive. ANCA positive associated vasculitis. The clinical manifestations were lack of specificity and easily misdiagnosed as other pulmonary diseases. The lesions were distributed symmetrically, mainly in the middle and lower lungs. The serum HDL decreased significantly in the majority of patients with ANCA positive associated vasculitis.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R593.2

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