Guillevin L, Lhote F, Brauner M, Casassus P
Service de Médecine Interne, Hôpital Avicenne, Bobigny.
Ann Med Interne (Paris). 1995;146(8):548-50.
Microscopic polyangiitis (MPA) is one of the vasculitides previously included in the polyarteritis nodosa (PAN) group. A diagnosis of MPA is usually considered when glomerulonephritis and/or lung hemorrhage are present. Small-sized vessels are involved and this sign is considered, for some authors, to be the main diagnostic criterion. The present study attempted to define clinical, radiological and immunological characteristics of MPA and to separate them from classic PAN (c-PAN) and Churg-Strauss syndrome. We have shown that, in most cases, patients presenting microaneurysms and/or multiple vessel stenoses, which reflect medium-sized vessel involvement, do not have ANCA. Conversely, patients with glomerulonephritis have almost never had abnormal angiograms. Furthermore, the clinical characteristics of ANCA-positive patients also indicate small-sized vessel involvement. Although at present it is not possible to definitively separate MPA from c-PAN, our results show that ANCA should be considered diagnostic for MPA and, in most cases, should be an exclusion criterion for c-PAN.
显微镜下多血管炎（MPA）是先前归类于结节性多动脉炎（PAN）组的血管炎之一。当存在肾小球肾炎和/或肺出血时，通常会考虑诊断为MPA。小血管受累，一些作者认为这一征象是主要诊断标准。本研究试图明确MPA的临床、放射学和免疫学特征，并将其与经典PAN（c-PAN）和变应性肉芽肿性血管炎区分开来。我们已经表明，在大多数情况下，出现微动脉瘤和/或多处血管狭窄（反映中等大小血管受累）的患者并无抗中性粒细胞胞浆抗体（ANCA）。相反，患有肾小球肾炎的患者几乎从未有过异常血管造影表现。此外，ANCA阳性患者的临床特征也提示小血管受累。虽然目前尚无法将MPA与c-PAN明确区分开来，但我们的结果表明，ANCA应被视为MPA的诊断依据，且在大多数情况下，应作为c-PAN的排除标准。
