Clinical Features And Prognostic Factors Of Microscopic Polyangiitis

Objective:To analyze the clinical characteristics and prognostic factors of microscopic polyangiitis().The aim is to strengthen clinicians’ understanding of the disease,intervene as soon as possible and improve the prognosis.Methods:The data of 90 patients with MPA diagnosed and followed up in the affiliated Hospital of Qingdao University from January 2013 to January 2019 were collected,such as general data(first diagnosis department,age,sex,course of disease),clinical manifestations,auxiliary examination,treatment plan,etc.,and their clinical characteristics were analyzed.According to the clinical prognosis,the patients were divided into complete remission group,partial remission group and non-remission group,and the differences of serological indexes were analyzed.Result:The male to female ratio of MPA patients was 1.14,the average age was(66.0 ±12.7)years,60% of the patients were ≥ 65 years old,and the median diagnosis time was 50 days.The clinical manifestations of MPA were complex and diverse,with 47.8% of patients complicated with fever and 43.3% of patients with fatigue.Renal involvement(hematuria,albuminuria,edema,etc.)accounted for 88.9%(80 cases),while renal function damage accounted for 54.4%(49 cases).The second was respiratory tract involvement(cough,expectoration,chest tightness,hemoptysis,etc.)51.1%(46 cases),of which 16 cases were complicated with alveolar hemorrhage such as hemoptysis.Digestive tract involvement(abdominal pain,diarrhea,abdominal distension,nausea,vomiting,anorexia,etc.)was30.0%(27 cases).Among the 90 patients,88 cases were positive for perinuclear ANCA(p-ANCA)/ anti-myeloperoxidase antibody(anti-MPO antibody),1 case for cytoplasmic ANCA(c-ANCA)/ anti-protease 3 antibody(PR3-Ab),and 1 case for c-ANCA/ anti-MPO antibody.Renal biopsy was performed in 18 patients with elevated creatinine,including crescent type in 10 cases(55.5%),focal type in 3 cases(16.7%),mixed type in 3 cases(16.7%),sclerosing in 1 case(5.6%),and membranous nephropathy in 1 case(5.6%).After treatment,CREA decreased in 8 cases of crescent type and long-term renal replacement(hemodialysis)in 2 cases.In focal type,CREA returned to normal in 2 cases,CREA in 1case decreased but not decreased to normal in 1 case,CREA did not decrease significantly in3 cases of mixed type,CREA increased in 1 case of sclerosing kidney disease,and CREA of1 case of membranous nephropathy decreased but not decreased to normal.The main findings of chest CT examination were interstitial fibrosis,plaque,cord shadow,inflammatory exudation,some complicated with bronchiectasis and infection,pleural effusion and so on.The main echocardiographic examination was valvular regurgitation and some of them were complicated with pericardial effusion.Cerebral CT or MRI examination mainly showed demyelination of cerebral vessels and cerebral infarction.Electromyography showed neurogenic damage in some patients.The albumin(ALB)in CR group was significantly higher than that in PR group and NR group,the ESR was significantly lower than that in PR group and NR group,the scores of sialic acid(SA),urea nitrogen(BUN),creatinine(CREA),C-reactive protein(CRP)and BVAS in CR group were significantly lower than those in NR group,and the hemoglobin(HGB)in CR group was significantly higher than that in NR group.The scores of BUN,CREA,CRP,ESR and BVAS in PR group were significantly lower than those in NR group,while ALB was higher than that in NR group,with statistical significance(P < 0.05).Conclusion:MPA can involve multiple systems,and the disease severity and clinical manifestations are different.ALB,ESR,CRP,SA,HGB,BUN,CREA and BVAS scores can be used as indicators to evaluate the prognosis of patients.