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目的分析显微镜下多血管炎(MPA)的肺部临床和影像学、实验室表现特点及其对治疗和预后的影响。方法回顾性分析2009年11月至2011年12月开封市第一人民医院收治的14例MPA患者的临床资料,对其肺部受累特点及死亡原因进行研究。结果 14例患者均有肺部受累,有症状者13例,有体征者14例。影像学上主要表现为肺部炎症、肺间质纤维化和肺泡出血,实验室检查中血气异常6例(6/6),心脏超声检查诊断肺动脉高压4例(4/9),肺功能异常6例(6/6),肺泡出血2例(15.4%),合并肺部感染7例(50.0%),死亡4例(28.57%),2例死于激素治疗时肺部感染,2例死于弥漫性肺泡出血。结论 MPA患者肺部受累发生率高,临床表现差异较大,弥漫性肺泡出血及合并肺部感染为MPA的主要死亡原因。
Objective To analyze the pulmonary clinical and radiological features of laboratory polyangiitis (MPA) under microscope and its laboratory characteristics and its impact on the treatment and prognosis. Methods The clinical data of 14 MPA patients admitted to the First People’s Hospital of Kaifeng City from November 2009 to December 2011 were retrospectively analyzed. The characteristics of lung involvement and the causes of death were studied. Results All the 14 patients had pulmonary involvement, 13 had symptoms and 14 had signs. Imaging mainly manifested as pulmonary inflammation, pulmonary interstitial fibrosis and alveolar hemorrhage, laboratory blood gas abnormalities in 6 cases (6/6), 4 cases of pulmonary hypertension (4/9), ultrasonography, pulmonary dysfunction 6 cases (6/6) had alveolar hemorrhage in 2 cases (15.4%), 7 cases (50.0%) had pulmonary infection, 4 died (28.57%), 2 died of pulmonary infection during hormone therapy and 2 died In diffuse alveolar hemorrhage. Conclusions The incidence of pulmonary involvement in MPA patients is high, and the clinical manifestations vary greatly. Diffuse alveolar hemorrhage and pulmonary infection are the major causes of MPA.