脊柱关节炎患者肾功能损害的患病率：来自国际 ASAS-COMOSPA 研究的结果。
The Prevalence of Renal Impairment in Patients with Spondyloarthritis: Results from the International ASAS-COMOSPA Study.
机构信息
From the Department of Rheumatology, and Biostatistics unit (DRCI), and Department of Nephrology, Gabriel Montpied University Hospital, Clermont-Ferrand; Department of Rheumatology, Paris Descartes University, and Hôpital Cochin; AP-HP; INSERM (U1153): Clinical epidemiology and biostatistics, PRES Sorbonne Paris-Cité, Paris, France.
M. Couderc, MD, Department of Rheumatology, Gabriel Montpied University Hospital; B. Pereira, PhD, Biostatistics unit (DRCI), Gabriel Montpied University Hospital; A. Molto, MD, PhD, Department of Rheumatology, Paris Descartes University, and Hôpital Cochin, and AP-HP, and INSERM (U1153): Clinical epidemiology and biostatistics, PRES Sorbonne Paris-Cité; A. Tiple, MD, Department of Nephrology, Gabriel Montpied University Hospital; M. Soubrier, MD, PhD, Department of Rheumatology, Gabriel Montpied University Hospital; M. Dougados, MD, PhD, Department of Rheumatology, Paris Descartes University, and Hôpital Cochin, and AP-HP, and INSERM (U1153): Clinical epidemiology and biostatistics, PRES Sorbonne Paris-Cité.
出版信息
J Rheumatol. 2018 Jun;45(6):795-801. doi: 10.3899/jrheum.170133. Epub 2018 Apr 15.
OBJECTIVE
To assess the prevalence and association of renal dysfunction in patients with spondyloarthritis (SpA).
METHODS
The ASAS-COMOSPA (Assessment of Spondyloarthritis international Society-COMOrbidities in SPondyloArthritis) was an international study (22 participating countries from 4 continents) investigating comorbidities in SpA. Renal function was assessed based on estimated glomerular filtration rate (eGFR) calculated using the Modification of Diet in Renal Disease equation. SpA characteristics and risk factors for renal impairment were collected. Nonsteroidal antiinflammatory drug (NSAID) use was assessed based on current intake (last 3 mos).
RESULTS
Of the 3984 patients recruited, 2098 (52.6%) were analyzed after excluding outliers and patients with no available eGFR measurement [male sex: 63.5%; age: 45.3 yrs; disease duration: 8.6 years; HLA-B27+: 73.1%; Bath Ankylosing Spondylitis Activity Index (BASDAI): 3.6/10]. Overall, 153 patients (5.2%, mean age: 53.6 yrs) exhibited an eGFR < 60 ml/min/1.73 m. In univariate analysis, renal impairment was associated with age (p < 0.001), HLA-B27 positivity (p = 0.003), several cardiovascular (CV) risk factors (history of hypertension, p < 0.001; systolic blood pressure, p = 0.009; diabetes, p = 0.005; and Framingham risk score, p < 0.001), disease activity scores [BASDAI, p = 0.001; Ankylosing Spondylitis Disease Activity Score-C-reactive protein (ASDAS-CRP), p < 0.001], functional variables (Bath Ankylosing Spondylitis Functional Index, p < 0.001), inflammatory biomarkers (erythrocyte and CRP, both p < 0.001), and NSAID intake since onset of disease (percentage of days, p = 0.008). However, there was no association with disease duration, disease severity, or ASAS-NSAID score. In multivariate analysis, age (45-59 yrs: OR 1.9, > 60 yrs: OR 6.2), HLA-B27 positivity (OR 0.51), and CRP (OR 1.3) remained significantly associated with eGFR < 60 ml/min/1.73 m.
CONCLUSION
Renal impairment was associated with age, HLA-B27 positivity, and inflammation, though not with CV risk factors, disease severity, or NSAID intake in patients with SpA.
目的
评估脊柱关节炎（SpA）患者肾功能障碍的患病率和相关性。
方法
ASAS-COMOSPA（评估脊柱关节炎国际协会-脊柱关节炎共病）是一项国际研究（来自 4 大洲的 22 个参与国家），调查了 SpA 的共病。根据使用改良肾脏病膳食研究方程计算的估计肾小球滤过率（eGFR）评估肾功能。收集 SpA 特征和肾功能损害的危险因素。根据最近（过去 3 个月）的摄入情况评估非甾体抗炎药（NSAID）的使用情况。
结果
在排除离群值和无可用 eGFR 测量值的患者后（男性：63.5%；年龄：45.3 岁；病程：8.6 年；HLA-B27+：73.1%；Bath 强直性脊柱炎活动指数（BASDAI）：3.6/10），共纳入 3984 名患者中的 2098 名（52.6%）进行分析。总体而言，153 名患者（5.2%，平均年龄：53.6 岁）表现出 eGFR < 60 ml/min/1.73 m。在单变量分析中，肾功能损害与年龄（p < 0.001）、HLA-B27 阳性（p = 0.003）、多种心血管（CV）危险因素（高血压史，p < 0.001；收缩压，p = 0.009；糖尿病，p = 0.005；弗雷明汉风险评分，p < 0.001）、疾病活动评分[BASDAI，p = 0.001；强直性脊柱炎疾病活动评分-C 反应蛋白（ASDAS-CRP），p < 0.001]、功能变量（Bath 强直性脊柱炎功能指数，p < 0.001）、炎症生物标志物（红细胞和 CRP，均 p < 0.001）和疾病发作以来的 NSAID 摄入（天数百分比，p = 0.008）相关。然而，与病程、疾病严重程度或 ASAS-NSAID 评分无相关性。在多变量分析中，年龄（45-59 岁：OR 1.9，> 60 岁：OR 6.2）、HLA-B27 阳性（OR 0.51）和 CRP（OR 1.3）与 eGFR < 60 ml/min/1.73 m 仍显著相关。
结论
在 SpA 患者中，肾功能损害与年龄、HLA-B27 阳性和炎症相关，但与 CV 危险因素、疾病严重程度或 NSAID 摄入无关。
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