Clinical Analysis Of12Cases Of ANCA-associated Vasculitis

Objective:To analyze clinical manifestation,assistant examination,therapy and prognosis of antineutrophil cytoplasmic antibody(ANCA)-associated vasculitis. Methods:Collect the clinical data of12cases diagnosed of ANCA-associated vasculitis, analysis the clinical manifestation, auxiliary examination,therapy and prognosis. Results:Among12cases,11cases were microscopic polyarteritis(MPA) and one case was Wegeners granulomatosis.9cases wereP-ANCA/MPO positive, and3cases were c-ANCA/PR3positive,2cases were GBM positive.The clinical symptom was complicated and dicersifed which included renal lesions in12cases(100%),pulmonary lesions in9cases (75.00%),enteral lesions in4cases (33.33%),arthralgia in5cases (41.67%), irregular fever in4cases (33.33%),hearing loss in2cases (16.67%), didymalgia in1case(8.35%),skin rash in2cases(16.67%), peripheral neuritis in2cases(16.67%),conjunctivitis in2cases(16.67%),courbature in2cases(16.67%), body weight loss in5cases (41.67%),anaemia in8cases (66.67%),etc.The most common manifestations of chest CT were interstitial pulmonary lesions(66.67%),other images were alveoli hemorrhagic change (22.22%) and nodular change(11.11%).The renal specimen biopsy demonstrated segmental fibrinoid necrosis of glomerular capillary in9 cases (75.00%), cellular crescent formed in5cases (41.67%) and cellular fibrous crescent formed in3cases (25.00%).The immunofluorescence were all negative.The laboratory tests showed that there were anaemia in8cases (66.67%), WBC increase in9cases (75.00%), PLT increase or normal in12cases(100%), ESR acceleration in12cases (100%),CRP increase in10cases (83.33%), serum IgG increase in3cases (25.00%) and compliment C3decrease in1case (8.35%). The patients were treated on induced remission stage with implosive therapy of cortiosteroids and cyclophosphamids, and assisted with plasma exchange、hemodialysis or immunoglobulin. They were treated with low dose prednisone on preserved remission stage,while azathioprine in2cases, and MMF in a1case. The BVAS before and after the therapy were contrasted with significant differences(17.42±5.26vs8.58±8.07,t=5.14,P<0.05).There were2cases dead and azotemia in4cases, maintenance hemodialysis in2cases. Conclusion: The onset clinical manifestation of ANCA-associated vasculitis was multiplex. The majority of the patients were elderly people,and the microscopic polyarteritis was even more commen than others.An ANCA test is helpful in early diagnosis,and timely comprehensive treatment can improve the prognosis.