S. Tang, MM, X. Li, MM, K.Y. Zhao, MM, Q. Zhou, MM, X.K. Tang, MD, Professor, Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
J Rheumatol. 2021 Mar;48(3):410-416. doi: 10.3899/jrheum.191042. Epub 2020 Jul 1.
To analyze the clinical features and prognostic factors of microscopic polyangiitis (MPA) with diffuse alveolar hemorrhage (DAH).
We conducted a retrospective study of 92 patients diagnosed with MPA with DAH at the First Affiliated Hospital of Chongqing Medical University between March 1, 2012, and March 12, 2018. The cumulative survival rate was analyzed by the Kaplan-Meier method, and survival curves were drawn. A Cox hazard model was used to determine the prognostic factors for survival by univariate and multivariate analysis.
The mean age at the onset of MPA with DAH was 66.32 years. Among the 92 MPA with DAH patients with follow-up visits, 41 (44.57%) were critically ill and 79 (85.87%) had pulmonary and renal involvement. The cumulative survival rates of the 92 patients at 1, 3, and 5 years were 63.7%, 51.2%, and 47.3%, respectively, and the median survival time was 46 months. In the multivariate analysis, age > 65 years (HR 4.30, 95% CI 1.94-9.55), sCr > 500 μmol/L (HR 2.04, 95% CI 1.05-3.97), PaO/FiO < 300 mmHg (HR 4.10, 95% CI 1.97-8.53), and lung involvement area ≥ 50% (HR 2.93, 95% CI 1.40-6.13) were independent prognostic factors ( < 0.05).
The incidence and mortality of DAH are high in MPA patients. Age > 65 years, sCr > 500 μmol/L, PaO/FiO < 300 mmHg, and lung involvement area ≥ 50% are independent prognostic factors for MPA with DAH.
分析显微镜下多血管炎（MPA）伴弥漫性肺泡出血（DAH）的临床特征和预后因素。
我们对 2012 年 3 月 1 日至 2018 年 3 月 12 日期间在重庆医科大学第一附属医院确诊为 MPA 伴 DAH 的 92 例患者进行了回顾性研究。采用 Kaplan-Meier 法分析累积生存率，并绘制生存曲线。采用单因素和多因素分析 Cox 风险模型确定生存的预后因素。
MPA 伴 DAH 患者发病时的平均年龄为 66.32 岁。92 例 MPA 伴 DAH 患者中，41 例（44.57%）为重症患者，79 例（85.87%）有肺部和肾脏受累。92 例患者的 1、3 和 5 年累积生存率分别为 63.7%、51.2%和 47.3%，中位生存时间为 46 个月。多因素分析显示，年龄＞65 岁（HR 4.30，95%CI 1.94-9.55）、sCr＞500 μmol/L（HR 2.04，95%CI 1.05-3.97）、PaO/FiO＜300mmHg（HR 4.10，95%CI 1.97-8.53）和肺部受累面积≥50%（HR 2.93，95%CI 1.40-6.13）是独立的预后因素（＜0.05）。
MPA 患者 DAH 的发生率和死亡率较高。年龄＞65 岁、sCr＞500μmol/L、PaO/FiO＜300mmHg 和肺部受累面积≥50%是 MPA 伴 DAH 的独立预后因素。
