Objective: To investigate the clinical characteristics of polyarteritis nodosa (PAN) patients with renal involvement. Methods: PAN patients admitted to the department of rheumatology, department of pediatrics, department of nephrology, general internal medicine department and department of vascular surgery at Peking Union Medical College Hospital from June 2012 to August 2018 were enrolled in this study and were divided into two groups according to renal involvement or not. The clinical characteristics were analyzed. Results: A total of 94 PAN patients were finally enrolled and 57 (60.64%) presented kidney manifestation. The mean age of onset was (37.76±17.40) years old and the interval from onset to diagnosis was 10 (0 to 240) months. Forty patients were misdiagnosed once or more times. In patients with renal involvement, 9 cases suffered from renal ischemia or infarction, 31 with microscopic haematuria, 26 with proteinuria, renal artery or its branch involved in 17 cases, renal vein thrombosis in 1 case, 4 cases with pyeloureterectasis, one case with renal fascia thickening, 33 cases with impaired renal function (serum creatinine>84 μmol/L) including creatinine>140 μmol/L in 10 patients. Renal artery branch stenosis was the most common presentation [9 cases (52.94%)] of renal vascular involvement, other abnormalities including nodular dilatation [4 cases (23.53%)], occlusion [3 cases (17.65%)]. There were significant differences (P<0.05) in the PAN patients with and without renal involvement in the following: age of onset [(33.72±16.13) years vs. (43.97±17.66) years, t(2)=2.901, P=0.005], weight loss(≥4kg since PAN onset) [25(43.86%) vs. 7(18.92%), χ(2)=6.216, P=0.013], elevation of diastolic blood pressure [22(38.60%) vs. 7(18.92%), χ(2)=4.072, P=0.044], acromegaly gangrene [18(31.58%) vs. 21(56.76%), χ(2)=5.859, P=0.015], and gastrointestinal artery involvement [20(35.09%) vs. 6(1.22%), χ(2)=3.993, P=0.046]. Laboratory parameters and the application of glucocorticoid and cyclophosphamide therapies were similar in two groups (all P>0.05). Conclusion: Young PAN patients are more likely to be associated with renal involvement, especially gastrointestinal arteries.
目的： 通过了解结节性多动脉炎（PAN）患者合并肾脏受累的临床特点，进一步提高临床医师对其认识，促进早期诊断、早期治疗，改善预后。 方法： 收集2012年6月至2018年8月北京协和医院住院的PAN患者的临床资料，根据是否肾脏受累，分析其临床特点。 结果： 共纳入94例PAN患者，其中肾脏受累者57例（60.64%），发病年龄（37.76±17.40）岁，起病至确诊时间0~240个月，中位时间10个月，42.55%（40/94）的患者确诊前有1次或多次误诊。肾脏受累者中肾缺血或梗死9例，镜下血尿31例，蛋白尿26例，肾动脉或其分支受累17例，肾静脉血栓1例，肾盂输尿管扩张4例，肾筋膜增厚1例，肾功能异常（血肌酐>84 μmol/L）33例，10例血肌酐>140 μmol/L。17例肾动脉或分支受累患者中以肾动脉分支受累最常见（10例），主要表现为肾动脉分支狭窄（9例）、瘤样扩张（4例）、闭塞（3例）。PAN肾脏受累者比未受累者发病更早[（33.72±16.13）岁比（43.97±17.66）岁，t=2.901，P=0.005]、更易出现体重下降[25例（43.86%）比7例（18.92%），χ(2)=6.216，P=0.013]、更易出现新发舒张压升高[22例（38.60%）比7例（18.92%），χ(2)=4.072，P=0.044]、肢端坏疽风险较低[18例（31.58%）比21例（56.76%），χ(2)=5.859，P=0.015]、更易合并胃肠动脉受累[20例（35.09%）比6例（1.22%），χ(2)=3.993，P=0.046]，PAN肾脏受累者与未受累者比相关实验室检查及应用糖皮质激素、环磷酰胺治疗差异无统计学意义（P值均>0.05）。 结论： 年轻PAN患者更易肾脏受累，此类患者需关注胃肠道血管受累情况。.
Keywords: Kidney; Polyarteritis nodosa; Vasculitis.