Massachusetts General Hospital, Boston.
Brigham and Women's Hospital, Boston, Massachusetts.
Arthritis Rheumatol. 2019 Nov;71(11):1879-1887. doi: 10.1002/art.41006. Epub 2019 Sep 16.
Patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) have an elevated risk of cardiovascular disease (CVD). This study was undertaken to develop a clearer understanding of the association between changes in disease activity and lipid levels in AAV, which may inform CVD risk stratification in this population.
Lipid levels were assessed in stored serum samples (obtained at baseline and month 6) from the Rituximab for ANCA-Associated Vasculitis (RAVE) trial, which randomized patients to receive either rituximab or cyclophosphamide followed by azathioprine. Paired t-tests and multivariable linear regression were used to assess changes in lipid levels.
Of the 142 patients with serum samples available, the mean ± SD age was 52.3 ± 14.7 years, 72 (51%) were male, 95 (67%) were proteinase 3 (PR3)-ANCA positive, 72 (51%) had received a new diagnosis of AAV, and 75 (53%) were treated with rituximab. Several lipid levels increased between baseline and month 6, including total cholesterol (+12.4 mg/dl [95% confidence interval (95% CI) +7.1, +21.0]), low-density lipoprotein (+10.3 mg/dl [95% CI +6.1, +17.1]), and apolipoprotein B (+3.5 mg/dl [95% CI +1.0, +8.3]). These changes were observed among newly diagnosed and PR3-ANCA-positive patients but not among those with relapsing disease or myeloperoxidase-ANCA-positive patients. There was no difference in change in lipid levels between rituximab-treated patients and cyclophosphamide-treated patients. Changes in lipid levels correlated with changes in erythrocyte sedimentation rate but not with other inflammatory markers or glucocorticoid exposure.
Lipid levels increased during remission induction among patients with newly diagnosed AAV and those who were PR3-ANCA positive. Disease activity and ANCA type should be considered when assessing lipid profiles to stratify CVD risk in patients with AAV.
抗中性粒细胞胞浆抗体（ANCA）相关性血管炎（AAV）患者发生心血管疾病（CVD）的风险增加。本研究旨在更清楚地了解 AAV 患者疾病活动度变化与血脂水平之间的关系，以便为该人群的 CVD 风险分层提供信息。
在 Rituximab for ANCA-Associated Vasculitis（RAVE）试验中评估了存储的血清样本（基线和第 6 个月采集）中的血脂水平，该试验将患者随机分配至接受利妥昔单抗或环磷酰胺加用硫唑嘌呤治疗。采用配对 t 检验和多变量线性回归评估血脂水平的变化。
在 142 例有血清样本的患者中，平均年龄 ± 标准差为 52.3 ± 14.7 岁，72 例（51%）为男性，95 例（67%）为蛋白酶 3（PR3）-ANCA 阳性，72 例（51%）为新诊断的 AAV，75 例（53%）接受利妥昔单抗治疗。多项血脂水平在基线和第 6 个月之间增加，包括总胆固醇（+12.4mg/dl[95%置信区间（95%CI）：7.1，+21.0]）、低密度脂蛋白（+10.3mg/dl[95%CI：6.1，+17.1]）和载脂蛋白 B（+3.5mg/dl[95%CI：1.0，+8.3]）。这些变化在新发疾病和 PR3-ANCA 阳性患者中观察到，但在复发疾病或髓过氧化物酶-ANCA 阳性患者中未观察到。利妥昔单抗治疗患者和环磷酰胺治疗患者的血脂水平变化无差异。血脂水平的变化与红细胞沉降率的变化相关，但与其他炎症标志物或糖皮质激素暴露无关。
新诊断的 AAV 患者和 PR3-ANCA 阳性患者在缓解诱导期间血脂水平升高。在评估 AAV 患者的血脂谱以分层 CVD 风险时，应考虑疾病活动度和 ANCA 类型。
