Choi Chan Bum, Park Yong Beom, Lee Sang Won
Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea.
Division of Rheumatology, Department of Internal Medicine, and Institute for Immunology and Immunological Diseases, Yonsei University College of Medicine, Seoul, Korea.
Yonsei Med J. 2019 Jan;60(1):10-21. doi: 10.3349/ymj.2019.60.1.10.
Antineutrophil cytoplasmic antibody-associated vasculitis (AAV) is a group of systemic necrotising vasculitides, which often involve small vessels, and which lead to few or no immune deposits in affected organs. According to clinical manifestations and pathological features, AAV is classified into three variants: microscopic polyangiitis, granulomatosis with polyangiitis (GPA), and eosinophilic GPA. The American College of Rheumatology 1990 criteria contributed to the classification of AAV, although currently the algorithm suggested by the European Medicines Agency in 2007 and the Chapel Hill Consensus Conference Nomenclature of Vasculitides proposed in 2012 have encouraged physicians to classify AAV patients properly. So far, there have been noticeable advancements in studies on the pathophysiology of AAV and the classification criteria for AAV in Western countries. However, studies analysing clinical features of Korean patients with AAV have only been conducted and reported since 2000. One year-, 5 year-, and 10 year-cumulative patient survival rates are reported as 96.1, 94.8, and 92.8%. Furthermore, initial vasculitis activity, prognostic factor score, age and specific organ-involvement have been found to be associated with either all-cause mortality or poor disease course. The rate of serious infection is 28.6%, and 1 year-, 5 year- and 10 year-cumulative hospitalised infection free survival rates range from 85.1% to 72.7%. The overall standardised incidence ratio of cancer in AAV patients was deemed 1.43 compared to the general Korean population.
抗中性粒细胞胞浆抗体相关性血管炎(AAV)是一组系统性坏死性血管炎,常累及小血管,且在受累器官中几乎不产生或不产生免疫沉积物。根据临床表现和病理特征,AAV可分为三种类型:显微镜下多血管炎、肉芽肿性多血管炎(GPA)和嗜酸性GPA。美国风湿病学会1990年的标准有助于AAV的分类,尽管目前欧洲药品管理局2007年建议的算法以及2012年提出的查珀尔希尔血管炎共识会议命名法鼓励医生对AAV患者进行正确分类。到目前为止,西方国家在AAV病理生理学和AAV分类标准的研究方面取得了显著进展。然而,自2000年以来才开始对韩国AAV患者的临床特征进行分析研究并报告。据报道,1年、5年和10年的累积患者生存率分别为96.1%、94.8%和92.8%。此外,已发现初始血管炎活动、预后因素评分、年龄和特定器官受累与全因死亡率或疾病进程不佳相关。严重感染率为28.6%,1年、5年和10年的累积无住院感染生存率在85.1%至