Kim Ho Jae, Yoo Juyoung, Jung Seung Min, Song Jason Jungsik, Park Yong Beom, Lee Sang Won
Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
Institute for Immunology and Immunological Diseases, Yonsei University College of Medicine, Seoul, Korea.
Yonsei Med J. 2018 Mar;59(2):294-302. doi: 10.3349/ymj.2018.59.2.294.
We investigated whether red blood cell distribution width (RDW) predicts vasculitis activity based on Birmingham vasculitis activity score (BVAS) or BVAS for granulomatosis with polyangiitis (GPA) at diagnosis and poor prognosis during follow-up in patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV).
We reviewed the medical records of 150 patients with AAV. We defined severe GPA as BVAS for GPA ≥7 (the highest quartile). Correlation and standardised correlation coefficients were analysed by linear regression tests. The differences between groups were evaluated by Mann-Whitney test. Relative risk (RR) was assessed by chi square test and Cox hazards model.
RDW was correlated only with the vasculitis activity of GPA among patients with AAV. An increase in RDW was associated with the absence of ear nose throat (ENT) manifestation, but not proteinase 3-ANCA. Significant differences were noted in cumulative refractory free survival according to RDW ≥15.4% (p=0.007) and the absence of ENT manifestation (p=0.036). Multivariate Cox hazards analysis identified RDW ≥15.4% as the only significant predictor of refractory disease in GPA (RR 17.573).
RDW predicts vasculitis activity in GPA, and RDW ≥15.4% at diagnosis may increase the risk of severe GPA at diagnosis and predict refractory diseases during follow-up.
我们研究了红细胞分布宽度（RDW）是否能基于伯明翰血管炎活动评分（BVAS）或肉芽肿性多血管炎（GPA）的BVAS预测抗中性粒细胞胞浆抗体（ANCA）相关血管炎（AAV）患者诊断时的血管炎活动情况以及随访期间的不良预后。
我们回顾了150例AAV患者的病历。我们将严重GPA定义为GPA的BVAS≥7（最高四分位数）。通过线性回归测试分析相关性和标准化相关系数。采用Mann-Whitney检验评估组间差异。通过卡方检验和Cox风险模型评估相对风险（RR）。
在AAV患者中，RDW仅与GPA的血管炎活动相关。RDW升高与无耳鼻喉（ENT）表现相关，但与蛋白酶3-ANCA无关。根据RDW≥15.4%（p = 0.007）和无ENT表现（p = 0.036），累积无难治性生存存在显著差异。多变量Cox风险分析确定RDW≥15.4%是GPA难治性疾病的唯一显著预测因素（RR 17.573）。
RDW可预测GPA中的血管炎活动，诊断时RDW≥15.4%可能增加诊断时严重GPA的风险，并预测随访期间的难治性疾病。
