基础医学与临床 ›› 2018, Vol. 38 ›› Issue (10): 1448-1451.

• 临床研究 • 上一篇    下一篇

类风湿关节炎合并ANCA相关性血管炎5例临床特点分析

汪海玥1,2,谷慧敏1,3,杨云娇1,李菁1   

  1. 1. 北京协和医院,北京协和医学院,中国医学科学院,国家教育部风湿免疫学重点实验室
    2. 烟台市中医医院风湿免疫科
    3. 河南中医药大学第二附属医院风湿免疫科
  • 收稿日期:2017-08-18 修回日期:2017-12-04 出版日期:2018-10-05 发布日期:2018-09-28
  • 通讯作者: 李菁 E-mail:lijing6515@pumch.cn
  • 基金资助:
    国家自然科学基金青年基金

Clinical features of 5 patients with rheumatoid arthritis complicated with ANCA-associated vasculitis

  • Received:2017-08-18 Revised:2017-12-04 Online:2018-10-05 Published:2018-09-28
  • Contact: Jing LI E-mail:lijing6515@pumch.cn

摘要: 目的 分析类风湿关节炎(RA)合并ANCA相关性血管炎(AAV)这一少见临床表现的特点。方法 回顾性分析北京协和医院2003年1月至2015年7月收治的5例RA合并AAV患者的临床特点、实验室检查、影像学资料及肾脏穿刺活检结果。结果 5例患者均为显微镜下多血管炎(MPA),女性3例,男性2例,MPA发病均晚于RA的诊断,除肾脏(100%)受累外,较易受累脏器为肺(60%)、耳鼻喉(20%)和眼(20%),易出现体重下降(40%)。结论 RA合并AAV是一种极为少见的临床表现,二者可能有共患易感性,在RA患者中出现肾损害需警惕合并AAV的可能,特别是不合并糖尿病、高血压及可疑药物应用史的患者。

关键词: ANCA相关性血管炎, 类风湿关节炎, 临床特点

Abstract: Objective To analyze the characteristics of rare clinical manifestation of rheumatoid arthritis(RA) with ANCA-associated vasculitis(AAV). Methods 5 hospitalized patients from Peking Union Medical College Hospital during January 2003 to July 2015 were diagnosed as RA with AAV. The medical records were retrospectively analyzed for clinical manifestations, laboratory examination, imaging findings, and pathological results of renal needle biopsy. Results 5 patients (3 female and 2 male) were diagnosed as microscopic polyangiitis (MPA), and all previously diagnosed with RA. All patients had renal abnormalities (100%), and pulmonary (60%), ENT (20%) and eye (20%) involvement was found. Wight loss was found in 2 patients. Conclusions RA with AVV is a rare clinical manifestation, but these two diseases may have a mutual genetic predisposition. Complication with AAV should be taken into considerations while new-onset renal abnormalities was found in RA patients without hypertension, diabetes, or related medication history.

Key words: ANCA-associated vasculitis, rheumatoid arthritis, clinical features