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17例抗中性粒细胞胞浆抗体相关性血管炎合并慢性鼻-鼻窦炎的临床分析

[Clinical analysis of 17 cases of anti-neutrophil cytoplasmic antibody associated vasculitis combined with chronic rhinosinusitis].

作者信息

Feng Q M, Wang H, Liu Z

机构信息

Department of Otorhinolaryngology Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.

出版信息

Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2019 Mar 7;54(3):181-186. doi: 10.3760/cma.j.issn.1673-0860.2019.03.004.

Abstract

To analyse the clinical characteristics of patients of anti-neutrophil cytoplasmic antibodies (ANCA)-associated vasculitis (AAV) combined with chronic rhinosinusitis (CRS) and its diagnostic strategy. A retrospective analysis of 228 patients with AAV treated in Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology from August 2008 to June 2018 was performed. Among them, 17 (7.5%, 17/228) patients(10 males and 7 females, with the range of age from 17 to 67 years old) had CRS and their clinical manifestations, laboratory examinations, treatment and prognosis were summarized and studied. In addition to nasal obstruction and increased nasal secretion, 17 AAV patients with CRS were accompanied by cough, wheezing and other pulmonary symptoms (5/17), fever (7/17) and anemia (7/17). Laboratoy tests showed positive ANCA (14/17), increased C-reactive protein (9/17), haematuria (8/17) and proteinuria (6/17). Except for 2 patients who went to other hospital, most patients (14/15) were relieved by glucocorticoid and immunosuppressive therapy. AAV patients with CRS may be accompanied by systemic and pulmonary symptoms (cough, asthma, fever, anemia, etc) or some positive laboratory tests (elevated C-reactive protein, proteinuria and/or hematuria, etc.). To achieve the goal of early diagnosis of AAV, ANCA test and biopsy are recommended for those patients with AAV and CRS concurrently.

摘要

分析抗中性粒细胞胞浆抗体(ANCA)相关血管炎(AAV)合并慢性鼻-鼻窦炎(CRS)患者的临床特征及其诊断策略。对2008年8月至2018年6月在华中科技大学同济医学院附属同济医院接受治疗的228例AAV患者进行回顾性分析。其中,17例(7.5%,17/228)患者(男10例,女7例,年龄17~67岁)合并CRS,总结并研究其临床表现、实验室检查、治疗及预后。17例合并CRS的AAV患者除鼻塞、鼻分泌物增多外,还伴有咳嗽、喘息等肺部症状(5/17)、发热(7/17)及贫血(7/17)。实验室检查显示ANCA阳性(14/17)、C反应蛋白升高(9/17)、血尿(8/17)及蛋白尿(6/17)。除2例转至其他医院的患者外,大多数患者(14/15)经糖皮质激素及免疫抑制治疗后病情缓解。合并CRS的AAV患者可能伴有全身及肺部症状(咳嗽、哮喘、发热、贫血等)或一些实验室检查阳性结果(C反应蛋白升高、蛋白尿和/或血尿等)。为实现AAV早期诊断的目标,建议对同时患有AAV和CRS的患者进行ANCA检测及活检。

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