Hasegawa Midori, Hattori Kyoko, Sugiyama Satoshi, Asada Hiroaki, Yamashita Hiroshi, Takahashi Kazuo, Hayashi Hiroki, Koide Shigehisa, Sato Waichi, Yuzawa Yukio
a Department of Nephrology , Fujita Health University School of Medicine , Toyoake, Aichi , Japan.
b Kanayama Clinic , Nagoya, Aichi , Japan.
Mod Rheumatol. 2016;26(1):110-4. doi: 10.3109/14397595.2015.1045255. Epub 2015 May 27.
This study investigated the clinical course of myeloperoxidase-antineutrophil cytoplasm autoantibody (MPO-ANCA)-associated vasculitis after starting dialysis.
A retrospective review was conducted of the clinical charts of dialysis-dependent patients with MPO-ANCA-associated vasculitis who attended one of 8 associated clinics over the past 21 years.
Eighty-nine patients were included in the study; 88 had microscopic polyangiitis (MPA) and 1 had granulomatosis with polyangiitis. Of the 88 patients with MPA, 18 had renal-limited vasculitis. Twenty-one relapses occurred among 13 patients (frequency, 0.05 relapses/person-year; 95% confidence interval, 0.03-0.08). Mean time from start of dialysis to relapse was 65 ± 59 months. Cox multivariate analysis showed that pulmonary involvement was a predictor of relapse (hazard ratio [HR], 21.4) and mortality (HR, 4.60), and that patient age (HR, 1.10) and cyclophosphamide use (HR, 0.20) were significant predictors of mortality. Postdialysis 1- and 5-year survival rates were 83.0% and 65.6%, respectively; infection was the most frequent cause of death.
Pulmonary involvement was a predictor of relapse and mortality. Although relapse can occur long after the start of dialysis, incidence was low among dialysis-dependent patients. Prolonged maintenance immunosuppressive therapy might be limited to patients with pulmonary involvement in dialysis-dependent ANCA-associated vasculitis.
本研究调查了开始透析后髓过氧化物酶-抗中性粒细胞胞浆抗体（MPO-ANCA）相关血管炎的临床病程。
对过去21年中在8家相关诊所之一就诊的依赖透析的MPO-ANCA相关血管炎患者的临床病历进行回顾性研究。
89例患者纳入研究；88例为显微镜下多血管炎（MPA），1例为肉芽肿性多血管炎。88例MPA患者中，18例为肾脏局限性血管炎。13例患者出现21次复发（复发频率，0.05次/人年；95%置信区间，0.03-0.08）。从开始透析到复发的平均时间为65±59个月。Cox多因素分析显示，肺部受累是复发（风险比[HR]，21.4）和死亡（HR，4.60）的预测因素，患者年龄（HR，1.10）和环磷酰胺使用情况（HR，0.20）是死亡的重要预测因素。透析后1年和5年生存率分别为83.0%和65.6%；感染是最常见的死亡原因。
肺部受累是复发和死亡的预测因素。虽然透析开始后很长时间可能会复发，但依赖透析的患者中复发率较低。对于依赖透析的ANCA相关血管炎患者，延长维持性免疫抑制治疗可能仅限于肺部受累患者。
