| Objective:Throught the analysis of the clinical characteristics of 82 cases of ANCA positive vasculitis,in order to understand more about the disease.Methods:A retrospective analysis of those patients’ s data who was diagnosed of AAV with ANCA positive in the First Affiliated Hospital of Guangxi Medical University from January 2015 to December 2016,such as basic information(age,gender,admission diagnosis,first diagnosis etc,clinical symptoms and auxiliary examination data.Results:In 82 patients,28 were male,54 were female,and ratio of male to female was 1:1.926,while the average age was 58.45±15.77 years old,the average time of initial diagnosis was 3 months.The clinical symptoms are not specific,main manifestion is renal involvement(such as hematuria,proteinuria,creatinine),systemic symptoms(such as Anorexia,fatigue,fever,weight loss)and respiratory symptoms(such as cough,expectoration,hemoptysis),approximately 89% of patients were misdiagnosed as other diseases,such as renal insufficiency and pneumonia.Laboratory examination results: 82 cases of patients with MPO-ANCA positive 74 cases,PR3-ANCA was positive in 8 cases,the ratio was 9.25:1,the average antibody titer was 1:50.45;besides the white blood cells increased in 34 cases(41.46%),neutrophils increased in 44 cases(53.55%),hemoglobin decreased in 78 cases(95.12%),79 cases with elevated ESR(96.34%),76 cases with elevated CRP(92.68%),59 cases with elevated creatinine(71.95%).High density lipoprotein(HDL)was significantly decreased in most patients(81.58%).The difference of cough,expectoration,hemoptysis,high sensitive C reactive protein and erythrocyte sedimentation rate(ESR)in AAV lung involvement and non lung involvement group was statistically significant(P < 0.05).Logistic multivariate analysis showed elevated high-sensitivity C reactive protein(OR=1.009,95% Cl 0.999 ~ 1.018,P=0.069(OR=1.010,95% Cl),erythrocyte sedimentation rate increased from 0.996 to 1.025,P=0.162),high sensitive C reactive protein and erythrocyte sedimentation rate has no correlation with whether AAV has lung involvement.Histological results: 32 cases with glomerulosclerosis,crescent formation in 19 cases,tubules imparied in 14 cases,8 cases with focal segmental necrosis,3 cases with mesangial hyperplasia;There are 1 cases with skin biopsy showed perivascular dermal equivalent in neutrophil infiltration.Results: the chest CT showed the main feature was interstitial changes,with ground glass shadow,grid,nodular opacities,interlobular septal thickening,honeycomb are more common,while may accompanied with pleural effusion,pleural thickening,lymphadenopathy,emphysema,bronchiectasis and cavity,lymph node calcification and other manifestation.The distribution characteristic of main lesion are: symmetrical,wide and partial lower.Conclusion: ANCA positive associated vasculitis mainly occurs in middle-aged and elderly women,and most patients are MPO-ANCA positive.The positive rate of pulmonary involvement in ANCA positive vasculitis is 43.9%,and the clinical manifestation is lack of specificity,which is easy to be misdiagnosed as other lung diseases.Chest CT is usually characterized that two the lung has different shapes,uneven density and irregular boundaries,and the lesions are symmetrically distributed,mainly in the middle and lower lungs.In most patients with ANCA positive vasculitis,serum HDL levels decreased significantly... |
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