血浆致动脉粥样硬化指数可预测抗中性粒细胞胞质抗体相关性血管炎中的脑血管意外发生。
Atherogenic index of plasma predicts cerebrovascular accident occurrence in antineutrophil cytoplasmic antibody-associated vasculitis.
机构信息
Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea, 03722.
Institute for Immunology and Immunological Diseases, Yonsei University College of Medicine, Seoul, Republic of Korea.
出版信息
Lipids Health Dis. 2020 Aug 14;19(1):184. doi: 10.1186/s12944-020-01360-1.
BACKGROUND
To investigate whether atherogenic index of plasma (AIP) at diagnosis is associated with the occurrence of cerebrovascular accident (CVA) or coronary artery disease (CAD) in antineutrophil cytoplasmic antibody-associated vasculitis (AAV).
METHODS
The medical records of 167 AAV patients on initial diagnosis was reviewed, and 300 healthy controls were included. AIP was calculated using the following equation: AIP = Log (triglyceride [mg/dL] / high-density lipoprotein cholesterol [mg/dL]). AAV patients were divided into two groups according to the AIP cut-off of 0.11. The event of stroke, transient ischemic attack, and cerebral hemorrhage was recorded as CVA, and CAD events consisted of either myocardial infarction and angina pectoris. CVA- and CAD- free survival rate between those with AIP ≥ 0.11 and < 0.11 were compared by the Kaplan-Meier analysis, and Cox hazard analysis was conducted to identify predictors of CVA.
RESULTS
The median age of AAV patients were 59.0 years, and 54 (32.3%) patients were male. One-hundred and fifteen (68.9%) patients had AIP < 0.11 and 52 (31.1%) had AIP ≥ 0.11. The mean Birmingham vasculitis activity score in AAV patients with AIP < 0.11 was lower than that seen in patients with AIP ≥ 0.11 (12.0 vs. 14.0, P = 0.041). AAV patients had a significantly higher AIP compared to controls (mean - 0.01 vs. -0.10, P < 0.001). During follow-up, the occurrence of CVA and CAD was observed in 16 (9.6%) and 14 (8.4%) patients, respectively. In Kaplan-Meier analysis, AAV patients with AIP ≥ 0.11 had significantly lower CVA-free survival rates than in those with AIP < 0.11 (P = 0.027), whereas there was no difference in CAD according to AIP (P = 0.390). Multivariable Cox analysis indicated that AIP ≥ 0.11 at diagnosis was the sole predictor of CVA (Hazard ratio 3.392, 95% confidence interval 1.076, 10.696, P = 0.037).
CONCLUSIONS
AIP is significantly higher in AAV patients than in healthy controls, and AIP ≥ 0.11 at diagnosis is a significant predictor of CVA during follow-up. Stringent surveillance should be provided in AAV patients with AIP ≥ 0.11 regarding the occurrence of CVA.
TRIAL REGISTRATION
Retrospectively registered (4-2017-0673).
背景
探讨载脂蛋白血浆指数（AIP）在诊断时是否与抗中性粒细胞胞浆抗体相关性血管炎（AAV）患者发生脑血管意外（CVA）或冠状动脉疾病（CAD）有关。
方法
回顾性分析了 167 例初诊 AAV 患者的病历，并纳入了 300 名健康对照者。使用以下公式计算 AIP：AIP=Log（甘油三酯[mg/dL] / 高密度脂蛋白胆固醇[mg/dL]）。根据 AIP 截断值 0.11，将 AAV 患者分为两组。将中风、短暂性脑缺血发作和脑出血记录为 CVA，CAD 事件包括心肌梗死和心绞痛。通过 Kaplan-Meier 分析比较 AIP≥0.11 和 AIP<0.11 的患者之间的 CVA 和 CAD 无事件生存率，并用 Cox 风险分析确定 CVA 的预测因素。
结果
AAV 患者的中位年龄为 59.0 岁，54 名（32.3%）患者为男性。115 名（68.9%）患者的 AIP<0.11，52 名（31.1%）患者的 AIP≥0.11。AIP<0.11 的 AAV 患者的 Birmingham 血管炎活动评分均值低于 AIP≥0.11 的患者（12.0 比 14.0，P=0.041）。与对照组相比，AAV 患者的 AIP 明显升高（平均-0.01 比-0.10，P<0.001）。在随访期间，16 名（9.6%）和 14 名（8.4%）患者分别发生了 CVA 和 CAD。在 Kaplan-Meier 分析中，AIP≥0.11 的 AAV 患者的 CVA 无事件生存率明显低于 AIP<0.11 的患者（P=0.027），而根据 AIP 则无 CAD 差异（P=0.390）。多变量 Cox 分析表明，诊断时 AIP≥0.11 是 CVA 的唯一预测因素（风险比 3.392，95%置信区间 1.076，10.696，P=0.037）。
结论
AAV 患者的 AIP 明显高于健康对照组，诊断时 AIP≥0.11 是随访期间发生 CVA 的显著预测因素。对于 AIP≥0.11 的 AAV 患者，应密切监测 CVA 的发生。
试验注册
回顾性注册（4-2017-0673）。
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