Université de Toulouse Paul Sabatier, Toulouse, France; Service de Médecine Interne, CHU Toulouse Purpan, Toulouse, France.
Université de Toulouse Paul Sabatier, Toulouse, France; Département de néphrologie et transplantation d'organe, CHU Toulouse Rangueil, Toulouse, France.
J Autoimmun. 2019 Jan;96:134-141. doi: 10.1016/j.jaut.2018.09.004. Epub 2018 Sep 17.
The aim of our study was to assess major cardiovascular event incidence, predictors, and mortality in ANCA-associated vasculitis (AAV).
We conducted a retrospective cohort study of all GPA or MPA, according to Chapel Hill Consensus Conference classification criteria, diagnosed between 1981 and 2015. Major cardiovascular event was defined as acute coronary artery disease, or ischemic stroke, or peripheral vascular disease requiring a revascularization procedure. We calculated the comparative morbidity/mortality figure (CMF) and we used Cox proportional hazards regression models to assess the risk of coronary artery disease, ischemic stroke associated with AAV, after adjusting for covariates.
125 patients, 99 GPA (79,2%) and 26 MPA (20,8%), were followed 88.4 ± 78.3 months. Ischemic stroke incidence was four times higher than in the general population (CMF 4,65; 95% CI 4,06-5,31). Coronary artery disease incidence was four times higher than in the general population (CMF 4,22; 95% CI 1,52-11,68). Smoking habits and history of coronary artery disease were strongly associated with coronary artery disease occurrence (adjusted HR 8.8; 95% CI 2.12-36.56, and adjusted HR 10.3; 95% CI 1.02-104.5, respectively). ENT flare-up was an independent protective factor for coronary artery disease occurrence. We did not identify factors significantly associated with stroke occurrence. The age-adjusted mortality rate was 22.5 per 1000 person-years. Mortality in AAV was 1.5 times higher than in the general population (CMF 1.56; 95% CI 1.34-1.83).
AAV have a significantly increased risk of mortality, ischemic stroke, and coronary artery disease.
本研究旨在评估抗中性粒细胞胞浆抗体（ANCA）相关性血管炎（AAV）患者主要心血管事件的发生率、预测因素和死亡率。
我们对根据 Chapel Hill 共识会议分类标准于 1981 年至 2015 年间诊断为 GPA 或 MPA 的所有患者进行了回顾性队列研究。主要心血管事件定义为急性冠状动脉疾病、缺血性卒中和需要血管重建术的外周血管疾病。我们计算了发病率/死亡率比值（CMF），并使用 Cox 比例风险回归模型评估了调整协变量后 AAV 相关冠状动脉疾病、缺血性卒中的发病风险。
125 例患者，99 例 GPA（79.2%）和 26 例 MPA（20.8%），平均随访 88.4±78.3 个月。缺血性卒中发生率是普通人群的 4 倍（CMF 4.65；95%CI 4.06-5.31）。冠状动脉疾病的发生率是普通人群的 4 倍（CMF 4.22；95%CI 1.52-11.68）。吸烟习惯和冠状动脉疾病史与冠状动脉疾病的发生密切相关（调整后的 HR 8.8；95%CI 2.12-36.56 和调整后的 HR 10.3；95%CI 1.02-104.5）。ENT 发作是冠状动脉疾病发生的独立保护因素。我们没有发现与卒中发生显著相关的因素。年龄调整后的死亡率为 22.5/1000 人年。AAV 的死亡率是普通人群的 1.5 倍（CMF 1.56；95%CI 1.34-1.83）。
AAV 的死亡率、缺血性卒中以及冠状动脉疾病风险显著增加。
