The Analysis Of ANCA-associated Vasculitis Clinical Features And Pathological Characteristics In 130 Cases

Objective:To discuss clinical characteristics and pathological characteristics of ANCA associated vasculitis in different digrees, compare the MPO-ANCA positive-small vasculitis with PR3-ANCA positive small vasculitis of epidemiology,clinical manifestation, etc.and Based on the characteristics of organ involvement and kidney pathology to discuss AAV to provide evidence for the diagnosis and treatment of ANCA associated vasculitis. Methods:Applied the jiuchuang and electronic medical record management information system to collect clinical records between January 2010 and December 2010, find all diagnosis for ANCA associated vasculitis of the medical records of 130 patients in the hospital, on the basis of ANCA test results,130 patients were divided into two groups: P-ANCA positive identification of myeloperoxidase(MPO),we called as MPO-ANCA,and c-ANCA positive identification of proteinase 3(PR3), we called as PR3-ANCA,compared the two groups of small vasculitis of clinical records, apply statistical methods for data analysis results. Results:In MPO-ANCA positive group,there were a total of 105 cases(80.7%), male, 40 cases(38.09%), female, 65 cases(61.90%), the male: female was 0.6:1, the average age of the patients was 62.76±12.80 years old, median age was 64 years old, patients over 55 years old there were 85 cases(80.95%). In PR3-ANCA positive group, there were a total of 25 cases(19.23%), the male 12 cases(48%), 13 cases(52%) of the female, male: female was 0.92:1, the average age of the patients was 53.04±14.72 years old, the median age of the patients was 56 years old, patients over 55 years old there were 13 cases(52%). The age when they were dignosed of ANCA-associated vasculitis was different(P<0.05).Lung and kidney were involved in the most patients of ANCA-associated vasculitis.The patients in MPO-ANCA positive group with lung performance as the first symptoms were more common than PR3-ANCA positive group, the difference was statistically significant(P<0.05), but with fuo, nose and eye symptoms, for starting symptom such as skin rash, PR3-ANCA positive patients were more common than MPO-ANCA positive group. In addition,The nasal symptoms as the first symptom was statistically diffrent(P<0.05). The occurrence rate of interstitial lung disease in MPO-ANCA positive group was higher than PR3- ANCA positive group(P<0.05), howerver the occurrence rates of eye, ear, nose, skin involvement were lower than PR3-ANCA positive group,in which the incidence of ear, nose involvement in patients was statistically different(P<0.05). Thrombocytosis(platelets > 300 * 10 ^ 9 / l), albumin lower(< 35 g/l) were more common in PR3-ANCA positive group, including the proportion of albumin decreased proportion was statistically different(P<0.05).There were a total of 102 cases who accepted chest CT examination, 96 cases have lung involvement, The occurrence rate of pleural effusion in MPO-ANCA positive group was lower than PR3-ANCA positive group, the difference is statistically significant(P<0.05). There were a total of 8 cases(6.15%) of AAV patients that only with lung involvement while there were a total of 7 cases(5.38%) with only renal involvement. The hemoglobin of patients with pure kidney damage was significantly lower than the pure lung involvement group, and white blood cell count turned out to be opposite,the difference was statistically significant(P<0.05).There were a total of 25 cases(19.23%) of AAV patients that with interstitial lung disease but not involved with increased serum creatinine, while with renal damage but not involved with pulmonary interstitial lesions were 79 cases(60.76%), The hemoglobin of patients with interstitial lung disease but not involved with increased serum creatinine was significantly higher than patients with renal damage but not involved with pulmonary interstitial lesions, furthermore the content of complement decreased much more in renal damage not involved with pulmonary interstitial lesions groups, the difference is statistically significant(P<0.05). MPO-ANCA positive cases were more common in the patients with interstitial lung disease but not involved with increased serum creatinine,while PR3-ANCA positive cases were opposite,the difference is statistically significant(P<0.05).Pathological data show renal biopsy immunofluorescence with no complement deposition were 24 cases(70.58%),while 10 cases(29.41%)with complement deposition.Compared the differences between the two groups of laboratory examination,indicated that peripheral blood leukocyte count on average of no complement deposits group of patients was higher than the group with complement deposition,the difference was statistically significant(P<0.05). In renal pathology, the normal number of glomerular in no complement deposits was statistically more than those with complement deposition.There were a total of 76 patients treated with glucocorticoid,combined the using of immunosuppressant cyclophosphamide there were 35 cases,application for mycophenolate mofeil were 5 cases, application of rituxan only 1 case,the application of mizoribine just 1 case, application of methotrexate in 1 case, combined with hemodialysis 25 cases, 9 cases rely only on hemodialysis without using glucocorticoid and immunosuppressant.The ANCA tests were negative when paitients went to hosipital the first time,4 paitients became positive separated in 4,3,1,2 years,of which 3 cases with pulmonary fibrosis,when patients suffered from renal abnormal,MPO-ANCA turned positive.A total of 9 cases of patients died in hospital for the first time in the hospital, 8 cases(7.62%) from the MPO-ANCA positive group,1 case(4%) from PR3-ANCA positive group. Conclusion:ANCA associated vasculitis can be mainly seen in middle-aged and old people, The age of onset of MPO-ANCA positive small vasculitis is older than PR3-ANCA associated vasculitis;The clinical manifestations lack of specificity,while the Pulmonary interstitial lesions in MPO-ANCA positive small vasculitis is more common. Patients mainly with renal invovement but not associated with interstitial lung disease are characterised by significantly lower serum complement and more severe anemia.