中国单中心回顾性队列研究：丙硫氧嘧啶诱导的 Graves 病患者抗中性粒细胞胞浆抗体相关性血管炎的临床特征和转归：中位随访 38 个月。

Clinical Characteristics and Outcomes of Propylthiouracil-Induced Antineutrophil Cytoplasmic Antibody-Associated Vasculitis in Patients with Graves' Disease: A Median 38-Month Retrospective Cohort Study from a Single Institution in China.

机构信息

1 Department of Nuclear Medicine, the First Affiliated Hospital, College of Medicine, Zhejiang University , Hangzhou, P.R. China .

2 Department of Radiology, the First Affiliated Hospital, College of Medicine, Zhejiang University , Hangzhou, P.R. China .

出版信息

Thyroid. 2017 Dec;27(12):1469-1474. doi: 10.1089/thy.2017.0468.

DOI:10.1089/thy.2017.0468

PMID:29088997

Abstract

BACKGROUND

This study sought to investigate the clinical characteristics and outcomes of propylthiouracil (PTU)-induced antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis in patients with Graves' disease.

METHODS

Sixteen patients diagnosed with PTU-induced ANCA-associated vasculitis at the authors' hospital from January 2010 to June 2017 were analyzed retrospectively.

RESULTS

All 16 patients with PTU-induced ANCA-associated vasculitis were female. The mean age ± standard deviation of the patients was 39.4 ± 15.3 years (range 19-69 years), and the median time of onset was 36 months (range 1-193 months) post-PTU initiation. The median dose at the onset of PTU-induced ANCA-associated vasculitis was 150 mg/day (range 50-300 mg/day). All patients had a positive serum perinuclear staining pattern (p-ANCA) and antibodies directed against myeloperoxidase (anti-MPO). Six patients tested positive for both anti-MPO antibodies and antibodies directed against proteinase-3. Seven (43.8%) patients presented with involvement of a single organ. The kidney was the organ most commonly affected, as 12 (75%) patients were found to have disease involving this organ. PTU was stopped in all patients, corticosteroids were administered to two patients, and immunosuppressive agents and corticosteroids were administered to five patients. Three patients were lost to follow-up. However, the remaining patients achieved remission after a median follow-up period of 38 months (range 6-76 months). Patients who were positive for pANCA and displayed cytoplasmic staining showed negative findings at rates of approximately 53.8% (7/13) and 100% (6/6), respectively, following treatment.

CONCLUSIONS

PTU-induced ANCA-positive vasculitis occurs at varying times and after exposure to various doses of PTU. The condition has a milder course and has a better prognosis after PTU cessation.

摘要

背景

本研究旨在探讨丙硫氧嘧啶（PTU）诱导的抗中性粒细胞胞质抗体（ANCA）相关性血管炎在格雷夫斯病患者中的临床特征和结局。

方法

回顾性分析了 2010 年 1 月至 2017 年 6 月作者医院诊断为 PTU 诱导的 ANCA 相关性血管炎的 16 例患者。

结果

16 例 PTU 诱导的 ANCA 相关性血管炎患者均为女性。患者的平均年龄（标准差）为 39.4±15.3 岁（范围 19-69 岁），PTU 起始后发病的中位时间为 36 个月（范围 1-193 个月）。PTU 诱导的 ANCA 相关性血管炎发病时的中位剂量为 150mg/天（范围 50-300mg/天）。所有患者血清胞浆型染色模式（p-ANCA）和抗髓过氧化物酶（anti-MPO）抗体均为阳性。6 例患者抗 MPO 抗体和抗蛋白酶 3 抗体均为阳性。7 例（43.8%）患者为单一器官受累。肾脏是最常受累的器官，12 例（75%）患者存在肾脏受累。所有患者均停用了 PTU，2 例患者给予了皮质类固醇，5 例患者给予了免疫抑制剂和皮质类固醇。3 例患者失访。然而，其余患者在中位随访 38 个月（范围 6-76 个月）后达到缓解。经治疗后，pANCA 阳性且显示胞浆染色的患者的阴性率分别约为 53.8%（7/13）和 100%（6/6）。