本文選題：髓過氧化物酶陽性的抗中性粒細胞胞漿抗體相關(guān)性血管炎　切入點：呼吸衰竭　出處：《復(fù)旦學(xué)報(醫(yī)學(xué)版)》2016年01期

【摘要】：目的分析髓過氧化物酶陽性的抗中性粒細胞胞漿抗體相關(guān)性血管炎(myeloperoxidase antineutrophil cytoplasmic antibody-associated vasculitis,MPO-AAV)患者臨床特點并探討肺部受累患者呼吸衰竭、肺部感染和死亡的危險因素。方法收集復(fù)旦大學(xué)附屬中山醫(yī)院2005年2月至2013年12月初診入院的MPO-AAV患者基線時臨床資料,截至2014年8月或死亡,應(yīng)用Logistic多因素回歸分析肺部受累患者不同預(yù)后的獨立危險因素。結(jié)果共納入98例確診的MPO-AAV患者,早期系統(tǒng)型13例,全身型50例,重型28例,難治型7例。呼吸系統(tǒng)以咳嗽咳痰、胸悶氣促為主要表現(xiàn);胸部X線和高分辨CT(high resolution computed tomography,HRCT)示以滲出(36例)、肺間質(zhì)改變(35例)常見;肺活檢示8例肺組織病理學(xué)見肺泡間隔破壞、慢性炎性細胞浸潤。糖皮質(zhì)激素治療92例,免疫抑制劑治療79例,兩種球蛋白治療19例,免疫吸附5例。治療后改善者71例,復(fù)發(fā)者17例。發(fā)生急性呼吸衰竭者16例,死亡9例,肺部感染者35例;分別以急性呼吸衰竭、死亡和肺部感染為終點,Logistic回歸分析肺部受累患者臨床資料發(fā)現(xiàn):肺部感染、肺間質(zhì)病變、Scr500μmol/L以及ALB30 g/L是急性呼吸衰竭的危險因素;發(fā)病年齡≥65歲、急性呼吸衰竭是患者死亡的危險因素;急性呼吸衰竭是患者肺部感染的危險因素。結(jié)論 MPO-AAV患者多有肺部受累,同時伴有全身及血液、腎臟等其他系統(tǒng)受累的異常表現(xiàn)。肺部感染是MPO-AAV肺部受累患者發(fā)生急性呼吸衰竭的主要誘發(fā)因素,且二者相互促進增加患者死亡風險;發(fā)病年齡65歲是呼吸衰竭患者死亡的危險因素。
[Abstract]:Objective to analyze the clinical features of myeloperoxidase antineutrophil cytoplasmic antibody-associated vasculitis (MPO-AAVV) patients with myeloperoxidase positive anti-neutrophil cytoplasmic antibody (ACA) and to investigate the risk factors of respiratory failure, pulmonary infection and death in patients with pulmonary involvement.Methods the clinical data of MPO-AAV patients who were hospitalized from February 2005 to December 2013 in Zhongshan Hospital affiliated to Fudan University were collected. By Aug. 2014 or death, Logistic multivariate regression analysis was used to analyze the independent risk factors for different prognosis of patients with pulmonary involvement.Results 98 cases of MPO-AAV were included, including early systemic type (13 cases), systemic type (50 cases), severe type (28 cases) and refractory type (7 cases).Chronic inflammatory cell infiltration.92 cases were treated with glucocorticoid, 79 cases were treated with immunosuppressant, 19 cases were treated with two kinds of globulin, and 5 cases were treated with immunosorbent.There were 71 cases of improvement and 17 cases of recurrence after treatment.There were 16 cases of acute respiratory failure, 9 cases of death and 35 cases of pulmonary infection.Scr500 渭 mol/L and ALB30 g / L were risk factors of acute respiratory failure, age 鈮，

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