中华风湿病学杂志
中華風濕病學雜誌
중화풍습병학잡지
CHINESE JOURNAL OF RHEUMATOLOGY
2014年
1期
34-38
,共5页
多动脉炎,结节性%肝炎病毒,乙型
多動脈炎,結節性%肝炎病毒,乙型
다동맥염,결절성%간염병독,을형
Polyarteritis nodosa%Hepatitis B virus
目的 探讨结节性多动脉炎(PAN)的临床特点,进一步提高对该病的认识.方法 2001年10月至2013年3月于北京协和医院住院的PAN患者65例.所有病例均进行乙型肝炎病毒表面抗原(HBsAg)检测,根据其结果分为HBsAg阴性和HBsAg阳性PAN组.对所有PAN患者的临床特点进行总结,并对HBsAg阴性和HBsAg阳性组进行对比分析.采用x2检验、Fisher确切概率法、t检验和MannWhitney检验进行统计学分析.结果 PAN患者的首诊误诊率高(51例,79％),男∶女=1.3∶1,平均年龄(37.6±1.6)岁.一般症状以发热(40例,62％)最为常见;系统受累以皮肤(51例,79％)、泌尿系统(44例,68％)、外周神经系统(22例,34％)、消化系统(21例,32％)受累常见.46例(71％)患者hs-CRP升高,11例(17％)患者嗜酸性粒细胞升高;血管受累以四肢动脉(22例,34％)最常见,其次是肾动脉(19例,29％)和胃肠道动脉(17例,26％).HBsAg阴性PAN组患者关节痛或关节炎较HBsAg阳性组更常见[22例(41％)与l例(9％),x2=4.00,P＜0.05],合并不良预后较HBsAg阳性组多[16例(30％)与0例(0),P＜0.05]、应用大剂量激素冲击治疗者较HBsAg阳性组多[16例(30％)与0例(0),P＜0.05].结论 PAN临床表现复杂.中青年患者出现原因不明的发热、皮疹、体质量下降、肌痛等非特异表现,合并泌尿系统、外周神经系统、消化系统等多系统损害,且自身抗体阴性时,应考虑PAN的可能.对于HBsAg阳性PAN患者的治疗更需兼顾控制PAN活动及乙型肝炎病毒活动两个方面.
目的 探討結節性多動脈炎(PAN)的臨床特點,進一步提高對該病的認識.方法 2001年10月至2013年3月于北京協和醫院住院的PAN患者65例.所有病例均進行乙型肝炎病毒錶麵抗原(HBsAg)檢測,根據其結果分為HBsAg陰性和HBsAg暘性PAN組.對所有PAN患者的臨床特點進行總結,併對HBsAg陰性和HBsAg暘性組進行對比分析.採用x2檢驗、Fisher確切概率法、t檢驗和MannWhitney檢驗進行統計學分析.結果 PAN患者的首診誤診率高(51例,79％),男∶女=1.3∶1,平均年齡(37.6±1.6)歲.一般癥狀以髮熱(40例,62％)最為常見;繫統受纍以皮膚(51例,79％)、泌尿繫統(44例,68％)、外週神經繫統(22例,34％)、消化繫統(21例,32％)受纍常見.46例(71％)患者hs-CRP升高,11例(17％)患者嗜痠性粒細胞升高;血管受纍以四肢動脈(22例,34％)最常見,其次是腎動脈(19例,29％)和胃腸道動脈(17例,26％).HBsAg陰性PAN組患者關節痛或關節炎較HBsAg暘性組更常見[22例(41％)與l例(9％),x2=4.00,P＜0.05],閤併不良預後較HBsAg暘性組多[16例(30％)與0例(0),P＜0.05]、應用大劑量激素遲擊治療者較HBsAg暘性組多[16例(30％)與0例(0),P＜0.05].結論 PAN臨床錶現複雜.中青年患者齣現原因不明的髮熱、皮疹、體質量下降、肌痛等非特異錶現,閤併泌尿繫統、外週神經繫統、消化繫統等多繫統損害,且自身抗體陰性時,應攷慮PAN的可能.對于HBsAg暘性PAN患者的治療更需兼顧控製PAN活動及乙型肝炎病毒活動兩箇方麵.
목적 탐토결절성다동맥염(PAN)적림상특점,진일보제고대해병적인식.방법 2001년10월지2013년3월우북경협화의원주원적PAN환자65례.소유병례균진행을형간염병독표면항원(HBsAg)검측,근거기결과분위HBsAg음성화HBsAg양성PAN조.대소유PAN환자적림상특점진행총결,병대HBsAg음성화HBsAg양성조진행대비분석.채용x2검험、Fisher학절개솔법、t검험화MannWhitney검험진행통계학분석.결과 PAN환자적수진오진솔고(51례,79％),남∶녀=1.3∶1,평균년령(37.6±1.6)세.일반증상이발열(40례,62％)최위상견;계통수루이피부(51례,79％)、비뇨계통(44례,68％)、외주신경계통(22례,34％)、소화계통(21례,32％)수루상견.46례(71％)환자hs-CRP승고,11례(17％)환자기산성립세포승고;혈관수루이사지동맥(22례,34％)최상견,기차시신동맥(19례,29％)화위장도동맥(17례,26％).HBsAg음성PAN조환자관절통혹관절염교HBsAg양성조경상견[22례(41％)여l례(9％),x2=4.00,P＜0.05],합병불량예후교HBsAg양성조다[16례(30％)여0례(0),P＜0.05]、응용대제량격소충격치료자교HBsAg양성조다[16례(30％)여0례(0),P＜0.05].결론 PAN림상표현복잡.중청년환자출현원인불명적발열、피진、체질량하강、기통등비특이표현,합병비뇨계통、외주신경계통、소화계통등다계통손해,차자신항체음성시,응고필PAN적가능.대우HBsAg양성PAN환자적치료경수겸고공제PAN활동급을형간염병독활동량개방면.
Objective To investigate the clinical characteristics of patients with polyarteritis nodosa (PAN),and to improve the understanding of the disease.Methods The data of 65 consecutive PAN patients admitted to Peking Union Medical College Hospital from October 2001 to March 2013 were analyzed.Patients were divided into two groups based on hapatitis B surface antigen (HBsAg) status.Chi-square test,Fisher exact probability,t test and Mann-Whitney test were used for statistical analysis.Results The male/female ratio of patients with PAN was 1.3/1,and the average age was (37.6±1.6) years old.Fever (in 40 cases,62％) was the most frequent manifestation.Skin was involved in 51 cases (79％),urologic involvement in 44 cases (68％),peripheral nervous system involvement in 22 cases (34％) and gastrointestinal involvement in 21 cases (32％).Forty-six (71％) patients had high-sensitivity C reactive protein (hs-CRP) elevation and 11 (17％) patients had eosinophil count elevation.The most common vascular involvements were limb arteries in 22 cases (34％),renal artery in 19 cases (29％),and gastrointestinal artery in 17 cases (26％).Patients with negative HBsAg had more frequent arthralgia or arthritis(41％ vs 9％,x2=4.00,P＜0.05),more indicators of poor prognosis (30％ vs 0,P＜0.05) and more glucocorticoid pulse therapy (30％ vs 0,P＜0.05) when compared with patients with positive HBsAg.Conclusion Clinical manifestations of PAN are complex.Young patients with fever of unknown origin,rash,weight loss,myalgias,accompanied by symptoms of multi-organ damage including urologic,peripheral nervous system,gastrointestinal involvement and negative autoantibodies should be highly suspected for the diagnosis of PAN.For the treatment of patients with positive HBsAg,special attention should be paid to maintain the delicate balance between controlling the organ damage caused by PAN and prevention of hepatitis B virus (HBV) infection reactivation.
