Lacou Mathieu, Leroy Maxime, Le Lan Nowenn, Toquet Claire, Espitia-Thibault Alexandra, Graveleau Julie, Masseau Agathe, Agard Christian, Volteau Christelle, Mussini Jean-Marie, Hamidou Mohamed, Néel Antoine
Internal Medicine Unit, Service de Médecine Interne, CHU de Nantes, 44093 Nantes France.
Délégation à la Recherche Clinique, CHU de Nantes, Nantes France.
Rheumatology (Oxford). 2021 Feb 1;60(2):699-707. doi: 10.1093/rheumatology/keaa233.
This study aimed to examine the sensitivity of muscle biopsy (MB) in ANCA-associated vasculitis (AAV), identify factors predicting MB positivity and assess the prognostic value of a positive MB.
We conducted a single-centre retrospective study of AAV with an MB performed at diagnosis. AAV classification [granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA), eosinophilic granulomatosis with polyangiitis (EGPA)] followed the European Medicines Agency algorithm. A logistic regression model was used to identify the factors associated with MB positivity. Survival curves were generated using the Kaplan-Meier method.
Among 276 AAV patients (1995-2018), 101 had an MB. Seventy-eight patients were included: 33 with GPA, 25 with MPA and 20 with EGPA. MB samples were positive in 45 cases (58%): 17 GPA, 16 MPA and 12 EGPA. Univariate analysis focussed on GPA and MPA, revealed that the MB yield was higher in females [22/31 (71%) vs 11/27 (41%); P = 0.02] and in anti-MPO patients [25/37 (68%) vs 6/19 (32%) for anti-PR3; P = 0.01]. By multivariate analysis, three factors predicted MB positivity: anti-MPO ANCA [odds ratio (OR) 10.67 (CI 2.09, 81.68)], female sex [OR 5.3 (CI 1.16, 32.35)] and neutrophil count [OR 1.33 (CI 1.07, 1.8)]. MB positivity had no impact on relapse, death or end-stage renal disease-free survival.
MB is a safe and efficient diagnostic tool for AAV. Predictors of MB yield include ANCA type, sex and neutrophil count. MB cannot substitute for kidney biopsy when indicated, but should be considered in other cases.
本研究旨在检测肌肉活检（MB）在抗中性粒细胞胞浆抗体相关性血管炎（AAV）中的敏感性，确定预测MB阳性的因素，并评估MB阳性的预后价值。
我们对诊断时进行了MB检查的AAV患者进行了单中心回顾性研究。AAV分类[肉芽肿性多血管炎（GPA）、显微镜下多血管炎（MPA）、嗜酸性肉芽肿性多血管炎（EGPA）]遵循欧洲药品管理局的算法。采用逻辑回归模型确定与MB阳性相关的因素。使用Kaplan-Meier方法生成生存曲线。
在276例AAV患者（1995 - 2018年）中，101例进行了MB检查。纳入78例患者：33例GPA、25例MPA和20例EGPA。MB样本45例（58%）呈阳性：17例GPA、16例MPA和12例EGPA。针对GPA和MPA的单因素分析显示，女性的MB阳性率更高[22/31（71%）对11/27（41%）；P = 0.02]，抗髓过氧化物酶（MPO）患者的MB阳性率更高[抗蛋白酶3（PR3）患者为6/19（32%），抗MPO患者为25/37（68%）；P = 0.01]。多因素分析显示，有三个因素可预测MB阳性：抗MPO抗中性粒细胞胞浆抗体[比值比（OR）10.67（95%置信区间2.09，81.68）]、女性性别[OR 5.3（95%置信区间1.16，32.35）]和中性粒细胞计数[OR 1.33（95%置信区间1.07，1.8）]。MB阳性对复发、死亡或无终末期肾病生存无影响。
MB是AAV一种安全有效的诊断工具。MB阳性率的预测因素包括抗中性粒细胞胞浆抗体类型、性别和中性粒细胞计数。在有指征时，MB不能替代肾活检，但在其他情况下应予以考虑。
