Henry Nicolas, Brilland Benoit, Wacrenier Samuel, Djema Assia, Garnier Anne Sophie, Gansey Renaud, Coindre Jean-Philippe, Besson Virginie, Duveau Agnès, Subra Jean-François, Cousin Maud, Piccoli Giorgina Barbara, Augusto Jean-François
Service de Néphrologie-Dialyse-Transplantation, Université d'Angers, CHU Angers, 4 rue Larrey, 49033 Angers CEDEX 09, France.
CHU d'Angers, Université d'Angers, INSERM U1232, CRCINA, 49000 Angers, France.
J Clin Med. 2020 Sep 30;9(10):3177. doi: 10.3390/jcm9103177.
(1) Introduction: The incidence of venous thromboembolisms (VTE) has not been extensively analyzed in patients with antineutrophil cytoplasmic antibody (ANCA)-glomerulonephritis (ANCA-GN). Thus, the aim of the present study was to assess the frequency and the risk factors of VTE in patients with ANCA-GN. (2) Methods: Patients from the Maine-Anjou ANCA-associated vasculitis (AAV) registry with a biopsy showing pauci-immune glomerulonephritis were included. VTE events, site, and interval from AAV diagnosis were analyzed. (3) Results: 133 patients fulfilled the inclusion criteria of the study and were analyzed. VTE episodes were diagnosed in 23/133 (17.3%) patients at a median delay of 3 months from ANCA-GN diagnosis. Patients with VTE had lower serum albumin ( = 0.040), were less frequently on statin therapy ( = 0.009) and had less frequently proteinase-3 (PR3)-ANCAs ( = 0.078). Univariate analysis identified higher age ( = 0.022), lower serum albumin ( = 0.030), lack of statin therapy ( = 0.009), and rituximab treatment ( = 0.018) as significant risk factors of VTE. In multivariate analysis, only lack of statin therapy (HR 4.873; = 0.042) was significantly associated with VTE. (4) Conclusion: Patients with ANCA-GN are at high risk of VTE, especially within the first months following AAV diagnosis. Our results suggest that statin therapy is associated with a lower risk of VTE in ANCA-GN patients.
(1) 引言：抗中性粒细胞胞浆抗体（ANCA）相关性肾小球肾炎（ANCA-GN）患者静脉血栓栓塞症（VTE）的发病率尚未得到广泛分析。因此，本研究的目的是评估ANCA-GN患者VTE的发生率及危险因素。(2) 方法：纳入缅因-安茹ANCA相关性血管炎（AAV）登记处活检显示寡免疫性肾小球肾炎的患者。分析VTE事件、发生部位以及自AAV诊断后的时间间隔。(3) 结果：133例患者符合研究纳入标准并接受分析。23/133（17.3%）例患者诊断为VTE，自ANCA-GN诊断起的中位延迟时间为3个月。发生VTE的患者血清白蛋白水平较低（P = 0.040），接受他汀类药物治疗的频率较低（P = 0.009），且抗蛋白酶3（PR3）-ANCA阳性的频率较低（P = 0.078）。单因素分析确定年龄较大（P = 0.022）、血清白蛋白水平较低（P = 0.030）、未接受他汀类药物治疗（P = 0.009）以及利妥昔单抗治疗（P = 0.018）是VTE的显著危险因素。多因素分析显示，仅未接受他汀类药物治疗（HR 4.873；P = 0.042）与VTE显著相关。(4) 结论：ANCA-GN患者发生VTE的风险较高，尤其是在AAV诊断后的最初几个月内。我们的结果表明，他汀类药物治疗与ANCA-GN患者较低的VTE风险相关。
