抗肾小球基底膜抗体伴抗中性粒细胞胞浆抗体阳性肾炎(四例报告及文献复习

来源 :中华肾脏病杂志 | 被引量 : 0次 | 上传用户:mumuduck
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目的 了解抗肾小球基底膜抗体( Anti G B M) 伴抗中性粒细胞胞浆抗体( A N C A) 阳性患者的临床病理特点。方法 对我科近4 年来68 例 Anti G B M 和( 或) A N C A 阳性患者进行 Anti G B M 及 A N C A 检测,对其中4 例两者均阳性患者进行临床病理分析。结果 68 例患者中4 例两者均阳性,占全部 Anti G B M 阳性患者的24 % ,占全部 A N C A 阳性患者的7 % 。该4 例患者 Anti G B M 的百分结合率较单纯 Anti G B M 阳性患者低。4 例中3 例髓过氧化物酶 A N C A( M P O A N C A) 阳性,1 例蛋白酶3 A N C A( P R3 A N C A) 阳性,全身系统表现较多,与单纯性 A N C A 阳性患者相似。所检病例肾脏病理多为新月体肾炎,免疫荧光检查多为 Ig G、 C3 呈细颗粒样分布于 G B M。虽经积极治疗,多数患者预后较差,类似单纯 Anti G B M 肾炎。结论  Anti G B M 伴 A N C A 阳性患者全身表现类似单纯 A N C A 相关小血管炎患者,但治疗效果及预后相对较差又类似于 Anti G B M 肾炎患者 Objective To investigate the clinicopathological features of Anti-G B M and anti-neutrophil cytoplasmic antibody (A N C A) -positive patients. Methods Anti-G B M and A N C A were detected in 68 cases of AntiG B M and / or A N C A positive patients in the past 4 years in our department. Clinicopathological analysis of 4 positive patients . Results Of the 68 patients, 4 were both positive, accounting for 24% of all Anti-G B M-positive patients and 7% of all A N C A-positive patients. The percentages of Anti-G B M in the 4 patients were lower than those in Anti-G B M-positive patients. In 4 cases, 3 cases of myeloperoxidase  A N C A (M P O  A N C A) positive, 1 case of protease 3  A N C A (P R3  A N C A) positive, systemic performance More, similar to simple A N C A positive patients. Most cases of renal pathology were crescentic nephritis, immunofluorescence mostly Ig G, C3 were finely distributed in the G B M. Despite aggressive treatment, the majority of patients with poor prognosis, similar to pure Anti GBM nephritis. Conclusion AntiG B M with A N C A positive patients with systemic manifestations similar to simple NA C A related vasculitis patients, but the treatment effect and prognosis is relatively poor and similar anti-G B M nephritis patients
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