Stassen P M, Derks R P H, Kallenberg C G M, Stegeman C A
Department of Internal Medicine, Medisch Spectrum Twente, PO box 50000, 7500 KA Enschede, The Netherlands.
Rheumatology (Oxford). 2008 Apr;47(4):530-4. doi: 10.1093/rheumatology/ken035.
In patients with ANCA-associated vasculitis (AAV), an increased incidence of venous thromboembolism (VTE), mainly during active disease, has been described. In a large cohort of AAV patients, we assessed the incidence of VTE and its relation with disease activity and classic risk factors for VTE.
Patients newly diagnosed with AAV between 1990 and 2005 and treated with cyclophosphamide and corticosteroids were included. Data were retrospectively retrieved from charts and by questionnaire. The incidence of VTE associated with and following a diagnosis of AAV was calculated (VTE/100 person-years) and related to periods with active disease.
One hundred and ninety-eight patients with AAV were followed for 6.1 (0.2-17.6) yrs. In 23 patients (12%), 25 VTEs (17 deep venous thromboses, 3 pulmonary emboli, 5 both) occurred in association with AAV, of which 52% occurred during active disease, defined as 3 months before and after diagnosis or relapse of AAV. Overall, VTE incidence was 1.8/100 person-years, increasing to 6.7/100 during active disease. VTEs occurred significantly less frequently in patients with WG than in patients with microscopic polyangiitis and renal limited vasculitis. Classic risk factors were present in most patients at some moment during follow-up. There were no significant differences in classic risk factors between patients with and without AAV-associated VTE.
Patients with AAV have an increased risk of developing VTEs, especially when AAV is active. This finding could not be explained by classic risk factors, but is probably related to endothelial changes and hypercoagulability induced by AAV and its therapy.
在抗中性粒细胞胞浆抗体相关性血管炎（AAV）患者中，已发现静脉血栓栓塞（VTE）的发生率增加，主要发生在疾病活动期。在一大群AAV患者中，我们评估了VTE的发生率及其与疾病活动度和VTE经典危险因素的关系。
纳入1990年至2005年间新诊断为AAV并接受环磷酰胺和皮质类固醇治疗的患者。数据通过回顾病历和问卷调查进行收集。计算AAV诊断前后相关的VTE发生率（每100人年的VTE发生率），并与疾病活动期相关。
198例AAV患者随访了6.1（0.2 - 17.6）年。23例患者（12%）发生了25次VTE（17次深静脉血栓形成，3次肺栓塞，5次两者皆有），其中52%发生在疾病活动期，定义为AAV诊断或复发前后3个月内。总体而言，VTE发生率为1.8/100人年，在疾病活动期增至6.7/100人年。韦格纳肉芽肿（WG）患者的VTE发生频率显著低于显微镜下多血管炎和肾脏局限性血管炎患者。大多数患者在随访期间的某些时刻存在经典危险因素。有或无AAV相关性VTE的患者在经典危险因素方面无显著差异。
AAV患者发生VTE的风险增加，尤其是在AAV活动时。这一发现无法用经典危险因素解释，可能与AAV及其治疗引起的内皮变化和高凝状态有关。
