抗中性粒细胞胞质抗体相关性血管炎的动脉和静脉血栓形成发生率高。
High Incidence of Arterial and Venous Thrombosis in Antineutrophil Cytoplasmic Antibody-associated Vasculitis.
机构信息
From the Imperial College Renal and Transplant Centre, Imperial College Healthcare UK National Health Service (NHS) Trust, London; Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London, London, UK.
A. Kang, FRACP, MBBS (Hons), Clinical Fellow, Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust; M. Antonelou, MRCP, BSc, Academic Clinical Fellow, Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust; N.L. Wong, FRACP, MBBS, Clinical Research Fellow, Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust; A. Tanna, MBBS, BSc, Clinical Research Training Fellow, Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London; N. Arulkumaran, PhD, MBBS, Renal Specialty Registrar, Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust; F.W. Tam, PhD, MB BChir, Ken and Mary Minton Chair of Renal Medicine, Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London; C.D. Pusey, DSc, MB BChir, Professor of Medicine, Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London.
出版信息
J Rheumatol. 2019 Mar;46(3):285-293. doi: 10.3899/jrheum.170896. Epub 2018 Nov 1.
OBJECTIVE
To determine the incidence of arterial thrombotic events (ATE) and venous thromboembolism (VTE) in antineutrophil cytoplasmic antibody-associated vasculitis (AAV).
METHODS
This is a retrospective cohort study presenting the incidence of ATE (coronary events or ischemic stroke) and VTE [pulmonary embolism (PE) or deep venous thrombosis (DVT)] in patients diagnosed with AAV between 2005 and 2014.
RESULTS
There were 204 patients with AAV who were identified. Median followup for surviving patients was 5.8 (range 1-10) years, accounting for 1088 person-years (PY). The incidence of ATE was 2.67/100 PY (1.56 for coronary events and 1.10 for ischemic stroke) and for VTE was 1.47/100 PY (0.83 for DVT only and 0.64 for PE with/without DVT). On multivariate analysis, prior ischemic heart disease (IHD) and advancing age were the only independent predictors of ATE. Among patients without prior IHD or stroke, the incidence of ATE remained elevated at 2.32/100 PY (1.26 for coronary events and 1.06 for ischemic stroke). ATE, but not VTE, was an independent predictor of all-cause mortality. Event rates for both ATE and VTE were highest in the first year after diagnosis of AAV but remained above the population incidence during the 10-year followup period. In comparison to reported rates for the UK population, the event rates in our AAV patients were 15-times higher for coronary events, 11-times higher for incident stroke, and 20-times higher for VTE.
CONCLUSION
Patients with AAV have a high incidence of arterial and venous thrombosis, particularly in the first year after diagnosis.
目的
确定抗中性粒细胞胞浆抗体相关性血管炎（AAV）患者中动脉血栓事件（ATE）和静脉血栓栓塞（VTE）的发生率。
方法
这是一项回顾性队列研究，报告了 2005 年至 2014 年间诊断为 AAV 的患者中 ATE（冠状动脉事件或缺血性卒中）和 VTE[肺栓塞（PE）或深静脉血栓形成（DVT）]的发生率。
结果
共确定了 204 例 AAV 患者。存活患者的中位随访时间为 5.8（1-10）年，共 1088 人年（PY）。ATE 的发生率为 2.67/100 PY（冠状动脉事件为 1.56，缺血性卒中为 1.10），VTE 的发生率为 1.47/100 PY（仅 DVT 为 0.83，有/无 DVT 的 PE 为 0.64）。多变量分析显示，既往缺血性心脏病（IHD）和年龄增长是 ATE 的唯一独立预测因素。在无既往 IHD 或卒中的患者中，ATE 的发生率仍高达 2.32/100 PY（冠状动脉事件为 1.26，缺血性卒中为 1.06）。ATE 而非 VTE 是全因死亡的独立预测因素。ATE 和 VTE 的事件发生率在 AAV 诊断后第一年最高，但在 10 年随访期间仍高于人群发生率。与英国人群的报告发生率相比，我们的 AAV 患者的冠状动脉事件发生率高 15 倍，新发卒中高 11 倍，VTE 高 20 倍。
结论
AAV 患者动脉和静脉血栓形成的发生率较高，尤其是在诊断后的第一年。
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