ГРАНУЛЕМАТОЗ С ПОЛИАНГИИТОМ, ПАТОГЕНЕТИЧЕСКИ СВЯЗАННЫЙ С АНТИНЕЙТРОФИЛЬНЫМИ ЦИТОПЛАЗМАТИЧЕСКИМИ АНТИТЕЛАМИ: ОСОБЕННОСТИ КЛИНИЧЕСКОГО ТЕЧЕНИЯ
https://doi.org/10.14412/1995-4484-2012-1288
Аннотация
На примере собственного опыта наблюдения 70 больных гранулематозом с полиангиитом (Вегенера) подробно изучены особенности течения клинических проявлений, отражающих гранулематозную воспалительную реакцию и некротизирующий полиангиит, проанализированы ранняя симптоматика, преморбидный фон, возможные провоцирующие факторы. Продемонстрировано, что гранулематозное воспаление и связанные с ним клинические проявления (в первую очередь псевдотумор орбиты и подскладочная гранулема гортани) с течением времени имеют тенденцию занимать доминирующее место в клинической картине заболевания, в то время как доля симптомов, условно относящихся к некротизирующему васкулиту, как правило, снижается. Расшифровка закономерностей развития гранулематоза с полиангиитом (Вегенера) может представлять ценность для дальнейшей разработки оптимальной лечебной стратегии.
Ключевые слова
Список литературы
1. <div><p>Falk R., Gross W., Guillevin L. et al. Granulomatosis with polyangiitis (Wegener's): an alternative name for Wegener's granulomatosis. A joint proposal of the American College of Rheumatology, the American Society of Nephrology, and the European League against Rheumatism. Arthr Rheum 2011; 63: 863-4.</p><p>Семенкова Е.Н. Системные некротизирующие васкулиты. М.: Русский врач, 2001; 96 с.</p><p>Hoffman G., Kerr G., Leavitt R. et al. Wegener granulomatosis: an analysis of 158 patients. Ann Intern Med 1992; 116: 488-98.</p><p>Watts R., Lane S., Hanslik T. et al. Development and validation of a consensus methodology for the classification of the ANCA-associated vasculitides and polyarteritis nodosa for epidemiological studies. Ann Rheum Dis 2007; 66: 222—7.</p><p>Jose R., Dilworth J., Cleverley J. et al. Wegener's granulomatosis with multiple pulmonary nodules — diagnostic difficulties. J R Soc Med Short Rep 2010; 1: 34.</p><p>Falk R., Jennette J. Тhought about the classification of small vessel vasculitis. J Nephrol 2004; 17: 3—9.</p><p>Luqmani R., Bacon P., Moots R. et al. Birmingham Vasculitis Activity Score (BVAS) in systemic necrotizing vasculitis. QJM 1994; 87: 671—8.</p><p>Pierrot-Deseilligny Despujol C., Pouchot J., Pagnoux C. et al. Predictors at diagnosis of a first Wegener's granulomatosis relapse after obtaining complete remission. Rheumatology 2010; 49: 2181—90.</p><p>Holl-Ulrich K., Reinhold-Keller E., Müller A., Feller A. Pathology of vasculitis: differential diagnosis and selected disorders. Verh Dtsch Ges Path 2002; 86: 83—90.</p><p>Witko-Sarsat V., Daniel S., Noël L., Mouthon L. Neutrophils and B lymphocytes in ANCA associated vasculitis. APMIS 2009; 117: 27—33.</p><p>Preston G., Yang J., Xiao H., Falk R. Understanding the pathogenesis of ANCA: Where are we today? Cleve Clin J Med 2002; 69: 51—4.</p><p>Lamprecht P., Gross W. Current knowledge on cellular interactions in the WG-granuloma. Clin Exp Rheumatol 2007; 25: 49—51.</p><p>Mark E., Matsubara O., Xan-Liu N., Fienberg R. The pulmonary biopsy in the early diagnosis of Wegener's (pathergic) granulematosis: a study based on 35 open lung biopsies. Hum Pathol 1988; 19: 1065—71.</p><p>Capraru D., Mü ller A., Csernok E. et al. Expansion of circulating NKG2D effector memory X cells and expression of NKG2D ligand MIC in granulomatous lesions in Wegener's granulomatosis. Clin Immunol 2008; 127: 144—50.</p><p>Raulet D. Roles of the NKG2D immunoreceptor and its ligands. Nat Rev Immunol 2003; 3: 781—90.</p><p>Hua F., Wilde B., Dolff S., Witzke O. T-lymphocytes and disease mechanisms in Wegener's granulomatosis. Kidney Blood Press Res 2009; 32: 389—98.</p><p>Lamprecht P., Holle J., Gross W. Update on clinical, pathophysiological and therapeutic aspects in ANCA associated vasculitides. Curr Drug Discovery Technol 2009; 6: 241—51.</p><p>Aries P., Lamprecht P., Gross W. Wegener's Granulomatosis: A view from the granulomatous side of the disease. IMAJ 2005; 7: 768—73.</p><p>Voswinkel J., Mueller A., Kraemer J. et al. B lymphocyte maturation in Wegener's granulomatosis: a comparative analysis of VH genes from endonasal lesions. Ann Rheum Dis 2006; 65: 859—64.</p><p>Baltaro R., Hoffman G., Sechler J. et al. Immunoglobulin G antineutrophil cytoplasmic antibodies are produced in the respiratory tract of patients with Wegener's granulomatosis. Am Rev Respir Dis 1991; 143: 275—8.</p><p>Krämer J., Mü ller A., Herlyn K. et al. B-Lymphozyten-Differenzierung in granulomatö sen Geweben der Lunge und der Nasenschleimhä ute beim Morbus Wegener Ursprungsort der ANCA-Bildung? Z Rheumatol 2007; 66: 421—9.</p><p>Müller A., Holl-Ulrich K., Lamprecht P., Gross W.L. Germinal centre-like structures in Wegener's granulomatosis: The morphological basis for autoimmunity? Rheumatology 2008; 47: 1111—3.</p><p>Weyand C., Seyler T., Goronzy J. B cells in rheumatoid synovitis. Arthr Res 2005; 7: 9—12.</p><p>Drayton D., Liao S., Mounzer R., Ruddle N. Lymphoid organ development: from ontogeny to neogenesis. Nat Immunol 2006; 7: 344—53.</p><p>Hurtado P., Jeffs L., Nitschke J. et al. CpG oligodeoxynucleotide stimulates production of anti-neutrophil cytoplasmic antibodies in ANCA associated vasculitis. BMC Immunol 2008; 9: 34.</p><p>Тadema H., Abdulahad W., Lepse N. et al. CpG triggers ANCA production by bloodderived B-cells from ANCA-associated vasculitis patients in clinical remission. APMIS 2009; 117: 116.</p><p>Stegeman C., Tervaert J., Sluiter W. et al. Association of chronic nasal carriage of Staphylococcus aureus and higher relapse rates in Wegener granulomatosis. Ann Intern Med 1994; 120: 12—7.</p><p>Popa E., Stegeman C., Abdulahad W. et al. Staphylococcal toxic-shocksyndrome-toxin-1 as a risk factor for disease relapse in Wegener's granulomatosis. Rheumatology 2007; 46: 1029—33.</p><p>Kobayashi O., Ohtami H., Hellmich B. Anti-MPO-ANCA-positive microscopic polyangiitis following subacute bacterial endocarditis. J Infect Chem 2001; 7: 228—38.</p><p>Tiliakos A., Tiliakos N. Dual ANCA positivity in subacute bacterial endocarditis. J Clin Rheumatol 2008; 14: 38—40.</p><p>Medina F., Camargo A., Moreno J., Zonana-Nacach A. et al. Anti-neutrophil cytoplasmic autoantibodies in leprosy. Br J Rheumatol 1998; 37: 270—3.</p><p>Flores-Suarez L., Cabiedes J., Villa A. et al. Prevalence of antineutrophil cytoplasmic autoantibodies in patients with tuberculosis. Rheumatology 2003; 42: 223—9.</p><p>De Rosa F., Amoroso A., Тeggi A. et al. Anti-neutrophil cytoplasmic antibodies in echinococcus granulosus hydatid disease. Hum Immunol 2001; 62: 1122—6.</p><p>Lamprecht P., Gutzeit O., Csernok E. et al. Prevalence of ANCA in mixed cryoglobulinemia and chronic hepatitis C virus infection. Clin Exp Rheumatol 2003; 21: S89—S94.</p><p>Hermann J., Demel U., Stunzner D. et al. Clinical interpretation of antineutrophil cytoplasmic antibodies: parvovirus B19 infection as a pitfall. Ann Rheum Dis 2005; 64: 641—3.</p><p>Lanham J., Elkon K., Pusey C., Hughes G. Systemic vasculitis with asthma and eosinophilia: a clinical approach to the Churg-Strauss syndrome. Medicine 1984; 63: 65—81.</p><p>Douglas G., Bird K., Flume P. et al. Wegener's granulomatosis in patients with rheumatoid arthritis. J Rheumatol 2003; 30: 2064—9.</p><p>Allen S., Harvey C. Imaging of Wegener's granulomatosis. Br J Radiol 2007; 80: 757—65.</p><p>Lohrmann C., Uhl M., Kotter E. et al. Pulmonary manifestations of Wegener granulomatosis: CТ findings in 57 patients and review of the literature. Eur J Radiol 2005; 53: 471—7.</p><p>Zycinska K., Wardyn K., Тyszko P., Otto M. Analysis of early death based on the prediction model in Wegener's granulomatosis with pulmonary and renal involvement. J Physiol Pharmacol 2007; 58: 829—37.</p><p>Bosch X. Microscopic polyangiitis (microscopic polyarteritis) with late emergence of generalised Wegener's granulomatosis. Ann Rheum Dis 1999; 58: 644—7.</p><p>Wiik A. Clinical and pathophysiological significance of anti-neutrophil cytoplasmic autoantibodies in vasculitis syndromes. Mod Rheumatol 2009; 19: 590—9.</p><p>Jayne D., Gaskin G., Pusey C., Lockwood C.M. ANCA and predicting relapse in systemic vasculitis. Q J Med 1995; 88: 127—33.</p><p>Hogan S., Falk R., Chin H. et al. Predictors of relapse and treatment resistance in antineutrophil cytoplasmic antibody-associated small-vessel vasculitis. Ann Intern Med 2005; 143: 621—31.</p><p>Bacon P. The spectrum of Wegener's granulomatosis and disease relapse. N Engl J Med 2005; 352: 330—2.</p><p>O'Connor B., Gleeson M., Noelle R., Erickson L. The rise and fall of long-lived humoral immunity: terminal differentiation of plasma cells in health and disease. Immunol Rev 2003; 194: 61—76.</p><p>Hoyer B., Moser K., Hauser A. et al. Short-lived plasmablasts and long-lived plasma cells contribute to chronic humoral autoimmunity in NZB/W mice. J Exp Med 2004; 199: 1577—84.</p><p>Holle J., Dubrau C., Herlyn K. et al. Rituximab for refractory granulomatosis with polyangiitis (Wegener's granulomatosis): comparison of efficacy in granulomatous versus vasculitic manifestations. Ann Rheum Dis 2012; 71: 327—33.</p><p>Falk R., Gross W., Guillevin L. et al. Granulomatosis with polyangiitis (Wegener's): an alternative name for Wegener's granulomatosis. A joint proposal of the American College of Rheumatology, the American Society of Nephrology, and the European League against Rheumatism. Arthr Rheum 2011; 63: 863—4.</p></div><br />
Рецензия
Для цитирования:
Beketova T.V. ГРАНУЛЕМАТОЗ С ПОЛИАНГИИТОМ, ПАТОГЕНЕТИЧЕСКИ СВЯЗАННЫЙ С АНТИНЕЙТРОФИЛЬНЫМИ ЦИТОПЛАЗМАТИЧЕСКИМИ АНТИТЕЛАМИ: ОСОБЕННОСТИ КЛИНИЧЕСКОГО ТЕЧЕНИЯ. Научно-практическая ревматология. 2012;50(6):19-28. https://doi.org/10.14412/1995-4484-2012-1288
For citation:
Beketova T.V. GRANULOMATOSIS WITH POLYANGIITIS, WHICH IS PATHOGENETICALLY ASSOCIATED WITH ANTINEUTROPHIL CYTOPLASMIC ANTIBODIES: CLINICAL FEATURES. Rheumatology Science and Practice. 2012;50(6):19-28. (In Russ.) https://doi.org/10.14412/1995-4484-2012-1288
Просмотров: 1574
Послать статью по эл. почте 