Clinical Features And TCM Syndromes Of 81 Cases Of Antineutrophil Cytoplasmic Antibody Associated Vasculitis Complicated With Interstitial Lung Disease

Objective:To investigate antineutrophil cytoplasmic antibody(ANCA)associated antibodies Clinical characteristics and common TCM syndromes of vasculitis(AAV)patients with interstitial lung disease(ILD).Methods:A total of 81 cases of AAV-ILD patients and 81 cases of non-AAV-ILD patients admitted to the Fourth Clinical College of Medicine,Xinjiang Medical University from January 2009 to January 2023 were studied.Clinical data,including clinical symptoms,signs and related laboratory indicators,were retrospectively collected.High-resolution CT of lung,full lung function,Warrick score,distribution of TCM syndrome types.Clinical characteristics and TCM syndrome types of AAV-ILD patients were analyzed,and AAV-ILD group was divided into c ANCA/PR3 positive group,p ANCA/MPO positive group and ANCA negative group.The clinical features of each subgroup were analyzed.Results:(1)The incidence of pulmonary heart disease,hypertension complications,Velcro rales,WBC,N,ESR,CRP,IL-6,D-dimer,peripheral blood leukocyte to lymphocyte ratio(W/L)and occult blood in AAV-ILD group were higher than those in non-AAV-ILD group,and the differences were statistically significant.The ratio of RBC,HGB,peripheral blood leukocyte to neutrophil(W/N)was lower than that of non-AAV-ILD group,and the difference was statistically significant.(2)DLCO% and W/L in AAV-ILD group were negatively correlated with Warrick’s total score,while W/N was positively correlated with Warrick’s total score.(3)Among 81 AAV-ILD patients,there were 38 cases(47.50%)of Qi deficiency and blood stasis,18 cases(22.50%)of phlegm turbidity blocking lung,12 cases(15.00%)of lung qi deficiency,7 cases(8.80%)of qi and Yin deficiency,3 cases(3.80%)of phlegm-heat obstructing lung,2cases(2.50%)of Yin deficiency.There was statistical difference between AAV-ILD group and non-AAV-ILD group in TCM syndrome types.(4)Compared with c ANCA/PR3 positive group,p ANCA/MPO positive group and ANCA negative group,WBC and N of p ANCA positive group were higher than those of ANCA negative group,and the differences were statistically significant,while HBC and HGB of p ANCA group were lower than those of c ANCA positive group,and the differences were statistically significant.(5)Among 81 cases of AAV-ILD patients,1-year follow-up,23 patients died,the mortality rate was 28.40%,including 11 patients died due to disease progression(47.83%),12 patients died due to infection(52.17%),1 patient died due to pulmonary embolism(4.35%),and 22 patients were lost to follow-up(27.16%),IL-6,coronary heart disease was an independent risk factor for death in AAV-ILD patients,and HGB was a protective factor.Conclusion:1.Positive WBC,N,ESR,CRP,IL-6,D-dimer and occult blood could provide theoretical basis for the early diagnosis and disease evaluation of AAV-ILD.2.Pulmonary heart disease and hypertension were common complications of AVA-ILD,The independent risk factors for death in AAV-ILD patients were IL-6,coronary heart disease,and HGB was a protective factor,and regular screening,early diagnosis and timely intervention were needed for high-risk groups.3.The TCM syndrome types of AAV-ILD patients were mainly Qi deficiency and blood stasis,phlegm turbidity and lung obstruction,which were easy to develop into lung qi deficiency syndrome.The treatment should be on the basis of removing phlegm and removing blood stasis.