抗中性粒细胞胞质抗体相关性血管炎的严重感染。
Severe Infection in Antineutrophil Cytoplasmic Antibody-associated Vasculitis.
机构信息
From Lund University, Department of Clinical Sciences Lund, Section of Rheumatology, and Orthopedics, Clinical Epidemiology Unit, and Section of Nephrology, Lund; Department of Medicine and Nephrology, Linköping University, Linköping, Sweden; Vasculitis and Lupus Clinic, Addenbrooke's Hospital, Cambridge, UK; Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, Massachusetts; Penn Vasculitis Center, Division of Rheumatology and Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
A.J. Mohammad, MD, PhD, Lund University, Department of Clinical Sciences Lund, Section of Rheumatology, and Vasculitis and Lupus Clinic, Addenbrooke's Hospital; M. Segelmark, MD, PhD, Department of Medicine and Nephrology, Linköping University; R. Smith, MA, Vasculitis and Lupus Clinic, Addenbrooke's Hospital; M. Englund, MD, PhD, Lund University, Department of Clinical Sciences Lund, Orthopedics, Clinical Epidemiology Unit, and Clinical Epidemiology Research and Training Unit, Boston University School of Medicine; J.Å. Nilsson, BSc, Lund University, Department of Clinical Sciences Lund, Section of Rheumatology; K. Westman, MD, PhD, Lund University, Department of Clinical Sciences Lund, Section of Nephrology; P.A. Merkel, MD, MPH, Penn Vasculitis Center, Division of Rheumatology and Department of Biostatistics and Epidemiology, University of Pennsylvania; D.R. Jayne, FMedSci, Vasculitis and Lupus Clinic, Addenbrooke's Hospital.
出版信息
J Rheumatol. 2017 Oct;44(10):1468-1475. doi: 10.3899/jrheum.160909. Epub 2017 Aug 1.
OBJECTIVE
To compare the rate of severe infections after the onset of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) with the rate in the background population, and to identify predictors of severe infections among patients with AAV.
METHODS
The study cohort was 186 patients with AAV diagnosed from 1998 to 2010, consisting of all known cases in a defined population in southern Sweden. For each patient, 4 age-and sex-matched reference subjects were randomly chosen from the background population. Using the Skåne Healthcare Register, all International Classification of Diseases codes of infections assigned from 1998 to 2011 were identified. Severe infections were defined as infectious episodes requiring hospitalization. Rate ratios were calculated by dividing the rate in AAV by the rate among the reference subjects.
RESULTS
The rate ratio for all severe infections was 4.53 (95% CI 3.39-6.00). The highest rate ratios were found for upper respiratory tract: 8.88 (3.54-25.9), 5.35 (1.54-23.8), nonspecific septicemia 4.55 (1.60-13.8), and skin 5.35 (1.69-19.8). Of the severe infections, 38.4% occurred within 6 months of diagnosis, 30.2% from 7-24 months, and 31.4% after 24 months. High serum creatinine and older age at diagnosis were associated with severe infection (p < 0.001). Of those with severe infection, 46.5% died during followup compared to 26% of patients without severe infection (p = 0.004).
CONCLUSION
Patients with AAV have markedly higher rates of severe infection compared with the background population, especially patients with older age and impaired renal function. The risk of severe infection is particularly high in the first 6 months following the diagnosis of vasculitis.
目的
比较抗中性粒细胞胞浆抗体（ANCA）相关性血管炎（AAV）发病后严重感染的发生率与背景人群的发生率，并确定 AAV 患者严重感染的预测因素。
方法
研究队列为 1998 年至 2010 年间诊断的 186 例 AAV 患者，由瑞典南部一个特定人群中所有已知病例组成。为每位患者随机选择 4 名年龄和性别匹配的背景人群参考对象。通过使用斯科讷医疗保健登记处，确定了 1998 年至 2011 年所有感染的国际疾病分类代码。严重感染定义为需要住院治疗的感染发作。通过将 AAV 中的发生率除以参考对象中的发生率来计算发生率比。
结果
所有严重感染的发生率比为 4.53（95%置信区间 3.39-6.00）。上呼吸道感染的发生率比最高，为 8.88（3.54-25.9）、5.35（1.54-23.8）、非特异性败血症 4.55（1.60-13.8）和皮肤 5.35（1.69-19.8）。严重感染中，38.4%发生在诊断后 6 个月内，30.2%发生在 7-24 个月，31.4%发生在 24 个月后。高血清肌酐和诊断时年龄较大与严重感染相关（p<0.001）。在发生严重感染的患者中，46.5%在随访期间死亡，而无严重感染的患者中 26%死亡（p=0.004）。
结论
与背景人群相比，AAV 患者严重感染的发生率明显更高，尤其是年龄较大和肾功能受损的患者。在血管炎诊断后的前 6 个月内，严重感染的风险特别高。
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