RESUMEN
Objective To analyze the clinical characteristics and prognosis of ANCA associated microvasculitis patients with gastrointestinal tract hemorrhage. Methods A retrospective analysis was conducted in 8 ANCA associated microvasculitis patients with gastrointestinal tract hemorrhage admitted to our hospital from May 1987 to May 2007. The statistical treatment is Kaplan-Meier. Results This group contained 4 male and 4 female patients. The average age was (39±20) years. The time from the onset of their disease to gastrointestinal bleeding was (8 ±8) months. Wegener's granulomatosis was the most common disease.Hematochezia(7/8 ) was the most common clinical manifestation and the distal small bowel (5/8) was the most common involved site. After the diagnosis was confirmed, methylprednisolone bolus therapy was used in 2 patients and 1～2 mg·kg-1·d-1 prednisone in 6 patients. Surgical operations were performed for 3 patients.However, 5 patients died. The prognosis was poor with the average survival time of (373±108) days. The mean survival time was (46 ±10) days after bleeding. Conclusion ANCA associated microvasculitis with gastrointestinal tract hemorrhage is rare. Early diagnosis and treatment could improve the prognosis.
RESUMEN
In order to determine the extent to which specific forms of glomerulonephritis (GN) contribute to the pool of crescentic GN, renal tissues from 17 crescentic GN patients were examined with special attention to glomerular and interstitial neutrophil infiltration. Renal tissues from five normal kidneys served as normal controls. Renal biopsy tissues from five patients with postinfectious GN in which crescent formation was not observed were also examined as disease controls. The patients were put into both three groups according to immunofluorescence findings and two groups according to the active or inactive phase of the crescents: group 1 with anti-glomerular basement membrane crescentic GN, one case; group 2 with immune complex crescentic GN, ten cases; and group 3 with pauci-immune crescentic GN, six cases. Four of the nine individuals tested were positive for anti-neutrophil cytoplasmic antibody (44.4%). Glomerular and interstitial neutrophil infiltrations were prominent in both the active and inactive phase groups, compared to normal controls (p<.05). Glomerular neutrophil infiltration was significantly prominent in the active phase group, compared to the inactive phase group (p<.001). In both the active and inactive phase groups, interstitial neutrophil infiltration was prominent, compared to disease control groups (p<.05). These results support the concept of the participation of periglomerular leukocytes in the renal tissue damage of crescentic GN, although the role of neutrophils was not examined.