关键词: 肺损害, 微型多血管炎, 人存活率, 危险因素

Abstract:

Ｏｂｊｅｃｔｉｖｅ：To analyze the clinical characteristics and longterm prognosis of patients with microscopic polyangiitis(MPA) with and without pulmonary involvement．
Ｍｅｔｈｏｄｏｌｏｇｙ：196 MPA patients with renal involvement were enrolled in the study. The median serum creatinine (SCr) was 3448 (1768~5569) μmol/L, 70(357%) of them needed renal replacement therapy at diagnosis. The prognosis and risk factor of MPA with pulmonary involvement were retrospectively studied. Survival Curve was estimated by KaplanMeier methods, and multivariate Cox regression analysis is applied to probe into the correlation between clinical features as well as pathological parameters and longterm human survival outcome.
Ｒｅｓｕｌｔｓ：With a mean followup time of 389±420 months, 20 patients died, 81(413%) developed end stage renal disease(ESRD). The pulmonary involvements were observed in 111 MPA patients, their main clinical symptoms included hemoptysis and  cough; CT or Xray manifestations included patchy, funicular shadow and pleural thickening. The age, proportion of male patients and smokers, BVAS score, serum creatinine and MPOANCA level in pulmonary involvement group were apparently higher than those of nonpulmonary involvement group (P<005). The 1year complete remission rate was 135% and 212% (P=0155) in patients with and without pulmonary involvement; while their ineffective treatment proportion was respectively 423% and 353% (P=0317). Patient survival rate in pulmonary involvement group was significantly lower (P=0013); renal survival was not differed between two groups. Cox multivariate analysis indicated that lung involvement and dialysis dependent on admission were significant negative prognostic factors for patients survival.
Ｃｏｎｃｌｕｓｉｏｎ：The vasculitis of older MPA patients with lung damage was more active. Lung involvement was an independent risk factor for human survival.

Key words: Lung damage, MPA, Patient , survival, Risk factor