抗中性粒细胞胞质抗体相关性血管炎病人血小板增多的临床意义

[文章编号]1000⁃2200(2024)02⁃0221⁃04㊃临床医学㊃

抗中性粒细胞胞质抗体相关性血管炎

病人血小板增多的临床意义

史家安1,刘　姣1,张　宁1,赵韵琦2,李志军2

(1.安徽省凤阳县人民医院肾内风湿科,233100;

2.蚌埠医科大学第一附属医院风湿免疫科,安徽蚌埠233004)

[摘要]目的:分析抗中性粒细胞胞质抗体相关性血管炎(AAV)病人周围血中血小板增多的临床意义㊂方法:分析110例AAV 病人临床与相关实验室资料,根据入院后首次周围血小板计数结果分为血小板正常组(n=67例)和血小板增多组(n=43例),对比2组病人的临床及相关实验检查数据,定期随访了解病人的生存情况㊂结果:单因素分析发现,2组性别㊁年龄㊁周围白细胞计数㊁中性粒细胞计数㊁淋巴细胞计数,血清补体C3水平,红细胞沉降率㊁血清C反应蛋白差异均有统计学意义(P< 0.05~P<0.01)㊂logistic回归分析发现性别㊁周围血白细胞计数㊁中性粒细胞计数是影响AAV病人合并血小板增多的独立危险因素(P<0.05)㊂血小板增多组强化治疗使用率相较于血小板正常组显著升高(P<0.05)㊂2组病人死亡率差异有统计学意义(P<0.01)㊂结论:AAV病人周围血小板增多时的病情较重,预后较差,应积极干预,通过早诊断㊁早治疗来改善预后㊂[关键词]血管炎;血小板;抗中性粒细胞胞质抗体

[中图法分类号]R543 [文献标志码]A DOI:10.13898/ki.issn.1000⁃2200.2024.02.018

Clinical significance of thrombocytosis in patients

with antineutrophil cytoplasmic antibody⁃associated vasculitis

SHI Jiaan1,LIU Jiao1,ZHANG Ning1,ZHAO Yunqi2,LI Zhijun2

(1.Department of Renal Rheumatology,Fengyang People′s Hospital,Fengyang Anhui233100;

2.Department of Rheumatology,The First Affiliated Hospital of Bengbu Medical University,Bengbu Anhui233004,China) [Abstract]Objective:To analyze the clinical significance of thrombocytosis in peripheral blood of patients with neutrophil cytoplasmic antibody⁃associated vasculitis(AAV).Methods:Clinical and relevant laboratory data of110AAV patients were analyzed.They were divided into a normal platelet group(n=67)and an increased platelet group(n=43)based on the first peripheral platelet count results after admission.The clinical and relevant experimental examination data of the two groups were compared,and the survival status of the patients was regularly followed up.Results:Univariate analysis found that there were statistically significant differences in gender, age,peripheral white blood cell count,neutrophil count,lymphocyte count,serum complement C3level,erythrocyte sedimentation rate, and serum C⁃reactive protein between the two groups(P<0.05to P<0.01).Logistic regression analysis found that gender,peripheral white blood cell count,and neutrophil count were independent risk factors for AAV patients with thrombocytosis(P<0.05).The usage rate of intensive therapy in the thrombocytopenia group was significantly higher than that in the normal platelet group(P<0.05).There was a statistically significant difference in mortality rates between the two groups of patients(P<0.01).Conclusions:The condition of AAV patients with increased peripheral platelets is severe and the prognosis is poor,active intervention should be taken to improve the prognosis through early diagnosis and treatment.

[Key words]vasculitis;platelet;antineutrophil cytoplasmic antibody

抗中性粒细胞胞质抗体相关性血管炎(AAV)是一组以血液循环中抗中性粒细胞胞质抗体(ANCA)阳性及小血管炎症与损伤为特点的坏死性血管炎性疾病㊂ANCA是小血管炎的生物学标志物,主要见于ANCA相关血管炎,也可见于自身免疫性肝病㊁药物诱导性血管炎[1]㊂AAV主要临床类型有显微镜下多血管炎(MPA)㊁肉芽肿性多血管炎(GPA)和嗜酸性肉芽肿性血管炎(EGPA)㊂AAV可累及全身多个系统和器官,临床表现复杂多样,极易造成误诊㊁误治㊂血小板是从骨髓成熟的巨核细胞胞质裂解脱落下来的小块胞质,其质与量受免疫细胞和炎症细胞活化的影响,参与多种自身免疫性疾

[收稿日期]2022-08-18　[修回日期]2023-09-28 [作者简介]史家安(1966-),男,硕士,副主任医师.