Li Qian, Yu Li-Chun, Li Feng-Xia, Wang Jing, Chen Yuan, Sun Shu-Zhen
Department of Pediatric Nephrology and Rheumatism and Immunology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China.
Department of Pediatric Nephrology and Rheumatism and Immunology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China.
Front Pediatr. 2021 Apr 15;9:645785. doi: 10.3389/fped.2021.645785. eCollection 2021.
The aim of this study was to explore the clinical features, pathological characteristics, and the prognosis of children with microscopic polyangiitis (MPA). Ten children with MPA that were hospitalized in our hospital were included in this study. The children's pre-diagnosis status, clinical manifestations, renal pathology, treatment, and prognosis data were analyzed retrospectively. All 10 cases included female patients with a median age of 8.9 years old at the time of diagnosis. MPO-ANCA antibody was positive in all cases, combined with a positive anti-GBM antibody in two cases. Nine cases had primary AAV and one had antithyroid drug (ATD)-associated MPA (secondary to methimazole). Renal involvement was found in all 10 patients, lung impairment was present in eight cases, and anemia was present in nine patients. Renal biopsies were performed in all 10 patients. Segmental focal or global glomerular necrosis was observed in 70% of the patients (7/10). The treatment mainly included steroid use combined with Cyclophosphamide and Mycophenolate. The follow-up s of the patients revealed normal renal function in eight patients and progression to end-stage renal disease (ESRD) in two patients. Female predisposition and positive MPO-ANCA antibody were prominent in children with MPA. The patients' kidneys and lungs were the most frequently involved organs. Corticosteroid combined with immunosuppressive therapy was recommended for the treatment of MPA. Early diagnosis, prompt aggressive treatment, and regular follow-ups are also very important factors associated with a good prognosis.
本研究旨在探讨显微镜下多血管炎(MPA)患儿的临床特征、病理特点及预后。本研究纳入了我院收治的10例MPA患儿。回顾性分析患儿诊断前状况、临床表现、肾脏病理、治疗及预后数据。10例患儿均为女性,诊断时中位年龄8.9岁。所有病例MPO-ANCA抗体均为阳性,2例合并抗GBM抗体阳性。9例为原发性小血管炎相关血管炎(AAV),1例为抗甲状腺药物(ATD)相关MPA(继发于甲巯咪唑)。10例患者均有肾脏受累,8例有肺部损害,9例有贫血。10例患者均行肾脏活检。70%(7/10)的患者观察到节段性局灶性或全球性肾小球坏死。治疗主要包括使用类固醇联合环磷酰胺和霉酚酸酯。对患者的随访显示,8例患者肾功能正常,2例进展为终末期肾病(ESRD)。女性易感性和MPO-ANCA抗体阳性在MPA患儿中较为突出。患者的肾脏和肺是最常受累的器官。推荐使用皮质类固醇联合免疫抑制疗法治疗MPA。早期诊断、及时积极治疗和定期随访也是与良好预后相关的非常重要的因素。