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目的研究丙基硫氧嘧啶(PTU)诱发的抗中性粒细胞胞质抗体(ANCA)阳性小血管炎的临床病理表现。方法对我院近2年诊治的3例PTU引起的ANCA阳性小血管炎进行临床病理分析并复习相关文献。结果3例病人均为女性,年龄24～32岁,平均28.3岁。服PTU时间2～17年,3例均出现皮疹、关节痛,但不累及肾、脑、肺、造血等重要脏器,均为核周型ANCA(pANCA),髓过氧化物酶ANCA(MPO-ANCA)显著增高(90～260EU/ml),1例并胞质型ANCA,2例抗甲状腺球蛋白抗体升高,1例抗核抗体(ANA)阳性,而同期服PTU、他巴唑(MMI)无小血管炎临床表现的格雷夫斯病血清14份、31份pANCA均阴性,PTU组有2例MPO-ANCA低水平增高(20～26EU/ml)。3例患者均立即停用PTU,改服MMI、甲亢平各1例,同时应用糖皮质激素,临床症状均缓解,各种自身抗体滴度降低。结论PTU可诱发ANCA阳性小血管炎,应及时发现停药,糖皮质激素治疗有效。
Objective To investigate the clinicopathological features of propylthiouracil (PTU) -mediated anti-neutrophil cytoplasmic antibody (ANCA) -positive vasculitis. Methods Three cases of ANCA-positive vasculitis caused by PTU in our hospital in the recent 2 years were analyzed clinically and pathologically and related literatures were reviewed. Results All 3 patients were female, aged from 24 to 32 years (average 28.3 years). PTU time 2 to 17 years, 3 cases were rash, joint pain, but does not affect the kidney, brain, lung, hematopoietic and other important organs, were perinuclear ANCA (pANCA), myeloperoxidase ANCA -ANCA) was significantly higher (90-260EU / ml), 1 case of cytoplasmic ANCA, 2 cases of anti-thyroglobulin antibody was elevated, 1 case of anti-nuclear antibody (ANA) was positive, while the same period served PTU, MMI) Graves’ serum with clinical manifestations of no small vasculitis, 14 of them were negative for pANCA and 2 of them were low level of MPO-ANCA in PTU group (20-26EU / ml). 3 patients were immediately discontinued PTU, change service MMI, hyperthyroidism in 1 case, while glucocorticoid, clinical symptoms were relieved, all kinds of autoantibody titers decreased. Conclusion PTU can induce ANCA positive vasculitis, should be promptly found withdrawal, glucocorticoid treatment is effective.