目的：探讨抗中性粒细胞胞浆抗体(antineutrophil cytoplasmic antibodies，ANCA)相关性血管炎(ANCA-associated small vessel vasculitis，AASV)的胸部CT表现。方法：回顾性分析2012年1月至2016年12月在苏州大学附属第一医院经血清学确诊的25例AASV患者的胸部CT表现。结果：25例患者中，男11例，女14例，年龄32~79岁(平均62)岁，其中胞浆型抗中性粒细胞胞浆抗体(cytoplasm antineutrophil cytoplasmic antibodies，c-ANCA)阳性5例，核周型抗中性粒细胞胞浆抗体(peripheral antineutrophil cytoplasmic antibodies，p-ANCA)阳性20例。胸部CT主要表现为间质性肺炎19例，斑片状磨玻璃影10例，结节及肿块7例，胸膜增厚5例，肺气肿肺大疱4例，支气管扩张4例，支气管充气征3例，空洞3例，胸腔积液3例，蜂窝肺1例，纵膈淋巴结肿大1例。在主要的3个影像学表现中，p-ANCA阳性患者中间质性肺炎的比例较高，较c-ANCA阳性患者而言，差异具有统计学意义(P<0.05)，而斑片状磨玻璃影、结节及肿块两者比较差异并无统计学意义(P>0.05)。结论：AASV患者胸部CT表现多样，以间质性肺炎、斑片状磨玻璃影、结节及肿块为主，p-ANCA阳性患者更易合并间质性肺炎。
Pulmonary CT findings in antineutrophil cytoplasmic antibodies-associated small vessel vasculitis
Objective: To investigate the pulmonary CT findings in antineutrophil cytoplasmic antibodies (ANCA) associated small vessel vasculitis(AASV). Methods: Clinical features of 25 patients with AASV hospitalized from January 2012 to December 2016 were randomly selected, and their pulmonary CT scans were analyzed retrospectively. Results: Of all the 25 AASV patients, 11 cases were male and 14 cases were female. The mean age of the subjects was 62 years old. These cases were divided into two groups: a cytoplasm antineutrophil cytoplasmic antibodies (c-ANCA) positive group (n=5) and a peripheral antineutrophil cytoplasmic antibodies (p-ANCA) positive group (n=20) in their peripheral serum. The pulmonary CT images were as follows: interstitial pneumonitis (n=19); patchy ground glass shadow (n=10); nodule and mass (n=7); pleural thickening (n=5); emphysema and bullae (n=4); bronchiectasis (n=4); air bronchogram (n=3); cavity (n=3); pleural effusion (n=3); honeycomb lung (n=1); enlarged mediastinal lymph nodes (n=1). In the three main CT images, the proportion of interstitial pneumonitis were significantly higher in patients with p-ANCA positive than that in the c-ANCA positive cases (P<0.05). There was no significant difference in patchy ground glass shadow, the nodule and mass involvements between two groups (P>0.05). Conclusion: The pulmonary CT imaging in AASV shows variety, mainly including interstitial pneumonitis, patchy ground glass shadow, and nodule and mass. The pulmonary CT scans in patients with p-ANCA positive are easy to show interstitial pneumonitis.