抗中性粒细胞胞浆抗体相关性血管炎肾受累患者及肾脏预后的临床、血清学和组织学决定因素：来自一家转诊中心的分析
Clinical, serological and histological determinants of patient and renal outcome in ANCA-associated vasculitis with renal involvement: an analysis from a referral centre.
作者信息
Crnogorac Matija, Horvatic Ivica, Toric Luka, Galesic Ljubanovic Danica, Tisljar Miroslav, Galesic Krešimir
机构信息
Department of Nephrology and Dialysis, Dubrava University Hospital, Avenija Gojka Šuška 6, 10 000, Zagreb, Croatia.
Department of Pathology, Dubrava University Hospital, Avenija Gojka Šuška 6, Zagreb, Croatia.
出版信息
Int Urol Nephrol. 2017 Aug;49(8):1419-1431. doi: 10.1007/s11255-017-1610-2. Epub 2017 Jun 23.
PURPOSE
To evaluate significance of clinical and histopathological prognostic factors for renal and patient outcome in AAV patient cohort.
METHODS
Retrospective study included consecutive patients diagnosed with pauci-immune crescentic glomerulonephritis from January 2003 to December 2013. Primary outcome was combined endpoint patient death or progression to end-stage renal disease (ESRD). Secondary outcomes were patient survival and progression to ESRD (renal survival) singularly and disease relapse. Kaplan-Meyer survival analysis and multivariate Cox proportional hazard regression analysis were used to explore difference between phenotypes and finding significant predictors regarding outcomes.
RESULTS
Out of 81 patients, 40.7% patients reached primary endpoint, 22.2% died, 29.6% reached ESRD and 16% relapsed during follow-up. Multivariate Cox proportional hazards regression-adjusted analysis found higher BVAS (HR 1.08, 95% CI 1.01-1.17, p = 0.042), higher baseline maximal serum creatinine (HR 1.02, 95% CI 1.01-1.03, p = 0.04) and lower haemoglobin (HR 0.97, 95% CI 0.95-0.99, p = 0.011) significantly associated with primary endpoint. Higher BVAS (HR 1.25, 95% CI 1.01-1.43, p = 0.001) and lower haemoglobin (HR 0.95, 95% CI 0.91-0.99, p = 0.008) were significantly associated with patient survival, while for renal survival, lower haemoglobin (HR 0.97, 95% CI 0.94-0.99, p = 0.041) and the need for acute haemodialysis (HR 3.15, 95% CI 1.20-8.26, p = 0.02) were significant predictors. On multivariate-adjusted analysis, no significant predictors for disease relapse were found. Kaplan-Meier survival analysis found no difference between clinical, serological and pathohistological phenotypes for all of the endpoints.
CONCLUSIONS
Renal function at presentation, anaemia and BVAS should be included in prediction models for the outcomes for the AAV patients.
目的
评估临床和组织病理学预后因素对显微镜下多血管炎（AAV）患者队列中肾脏及患者预后的意义。
方法
回顾性研究纳入了2003年1月至2013年12月期间连续诊断为少免疫性新月体性肾小球肾炎的患者。主要结局是患者死亡或进展为终末期肾病（ESRD）的复合终点。次要结局分别为患者生存、进展为ESRD（肾脏生存）以及疾病复发。采用Kaplan-Meier生存分析和多变量Cox比例风险回归分析来探讨不同表型之间的差异，并找出与结局相关的显著预测因素。
结果
81例患者中，40.7%的患者达到主要终点，22.2%的患者死亡，29.6%的患者进展为ESRD，16%的患者在随访期间复发。多变量Cox比例风险回归调整分析发现，较高的伯明翰血管炎活动评分（BVAS）（风险比[HR] 1.08，95%置信区间[CI] 1.01 - 1.17，p = 0.042）、较高的基线血清肌酐最高值（HR 1.02，95% CI 1.01 - 1.03，p = 0.04）和较低的血红蛋白水平（HR 0.97，95% CI 0.95 - 0.99，p = 0.011）与主要终点显著相关。较高的BVAS（HR 1.25，95% CI 1.01 - 1.43，p = 0.001）和较低的血红蛋白水平（HR 0.95，95% CI 0.91 - 0.99，p = 0.008）与患者生存显著相关，而对于肾脏生存，较低的血红蛋白水平（HR 0.97，95% CI 0.94 - 0.99，p = 0.041）和急性血液透析需求（HR 3.15，95% CI 1.20 - 8.26，p = 0.02）是显著的预测因素。在多变量调整分析中，未发现疾病复发的显著预测因素。Kaplan-Meier生存分析发现，所有终点在临床、血清学和病理组织学表型之间均无差异。
结论
就诊时的肾功能、贫血和BVAS应纳入AAV患者预后的预测模型中。
Zotero 插件