Department of Internal Medicine and Clinical Immunology, Normandie Univ, UNICAEN, CHU de Caen Normandie, Caen, France.
Department of Immunology, Normandie Univ, UNICAEN, CHU de Caen Normandie, Caen, France.
Rheumatology (Oxford). 2019 Oct 1;58(10):1731-1739. doi: 10.1093/rheumatology/kez016.
In ANCA-associated vasculitis (AAV), classifications have emerged to individualize homogeneous clinical and outcomes patterns, including the recently defined anti-MPO granulomatosis with polyangiitis (GPA) subgroup. This study aimed to retrospectively evaluate the impacts of re-classification based on clinicopathological criteria and/or ANCA specificity.
A retrospective monocentric study conducted at Caen University Hospital led to the identification of PR3 or MPO-ANCA AAV patients from January 2000 or September 2011, respectively, to June 2016. Eosinophilic GPA patients were excluded. AAVs were thereby also classified either as GPA or microscopic polyangiitis (MPA) according to the European Medicines Agency vasculitis algorithm.
A total of 150 AAV patients were included (94 GPA, 56 MPA; 87 anti-PR3 and 63 anti-MPO patients). GPA patients exhibited a worse relapse-free survival but a better renal survival (P < 0.001 and P = 0.021, respectively) than MPA patients. Overall, relapse-free and renal survival rates were similar between anti-PR3 and anti-MPO patients (P = 0.35, 0.17 and 0.15, respectively). Similarly, the prognosis was identical between anti-MPO MPA patients and anti-PR3 MPA patients (P = 0.33, 0.19 and 0.65, respectively), and between anti-MPO GPA patients and anti-PR3 GPA patients (P = 0.06, 0.99 and 0.64, respectively). Moreover, anti-PR3 GPA and anti-MPO GPA patients exhibited no differences in clinical manifestations or BVAS score.
Clinicopathological classification appeared to be the strongest criterion for distinguishing among homogeneous prognoses of AAV. Individualizing the anti-MPO GPA subgroup does not appear to bring additional value to clinical practice, but multicentre studies are required to confirm this trend.
在抗中性粒细胞胞浆抗体（ANCA）相关性血管炎（AAV）中，已经出现了分类方法，以将具有相似临床表现和结局的患者区分开来，包括最近定义的抗髓过氧化物酶肉芽肿性多血管炎（GPA）亚组。本研究旨在回顾性评估基于临床病理标准和/或 ANCA 特异性进行重新分类的影响。
在卡昂大学医院进行的一项回顾性单中心研究中，分别从 2000 年 1 月或 2011 年 9 月至 2016 年 6 月期间，确定了 PR3 或 MPO-ANCA AAV 患者。排除嗜酸性粒细胞性 GPA 患者。根据欧洲药品管理局血管炎算法，AAV 也被分类为 GPA 或显微镜下多血管炎（MPA）。
共纳入 150 例 AAV 患者（94 例 GPA，56 例 MPA；87 例抗 PR3 和 63 例抗 MPO 患者）。与 MPA 患者相比，GPA 患者无复发生存率更差，但肾脏存活率更好（P<0.001 和 P=0.021）。总体而言，抗 PR3 和抗 MPO 患者之间的无复发生存率和肾脏存活率相似（P=0.35、0.17 和 0.15）。同样，抗 MPO MPA 患者和抗 PR3 MPA 患者之间的预后也相同（P=0.33、0.19 和 0.65），抗 MPO GPA 患者和抗 PR3 GPA 患者之间的预后也相同（P=0.06、0.99 和 0.64）。此外，抗 PR3 GPA 和抗 MPO GPA 患者的临床表现或 BVAS 评分无差异。
临床病理分类似乎是区分 AAV 相似预后的最强标准。对抗 MPO GPA 亚组进行个体化分类似乎对临床实践没有额外价值，但需要进行多中心研究来证实这一趋势。
