Internal Medicine Service, Parc Tauli Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Catalonia, Spain.
Internal Medicine Service, Hospital Universitari Vall d'Hebrón, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain.
Clin Exp Immunol. 2021 Feb;203(2):209-218. doi: 10.1111/cei.13530. Epub 2020 Nov 2.
Long-term observation of patients with ANCA-associated vasculitis (AAV) allows the identification of different longitudinal patterns of ANCA levels during follow-up. This study aimed to characterize these patterns and to determine their prognostic significance. All ANCA determinations performed in two university hospitals during a 2-year period were retrospectively reviewed. Patients were included in the analysis if they had high titers of anti-myeloperoxidase (anti-MPO) or anti-proteinase 3 (anti-PR3) antibodies at least once, ≥ 5 serial ANCA determinations and AAV diagnosed by biopsy or American College of Rheumatology (ACR) classification criteria. Patients' time-course ANCA patterns were classified as monophasic, remitting, recurrent or persistent. Associations between ANCA patterns and prognostic variables (relapse rate and renal outcome) were analysed by univariate and multivariate statistics. A total of 99 patients [55 with microscopic polyangiitis (MPA), 36 with granulomatosis with polyangiitis (GPA) and eight with eosinophilic granulomatosis with polyangiitis (EGPA)] were included. Median follow-up was 9 years. Among patients diagnosed with MPA or GPA, recurrent or persistent ANCA patterns were associated with a higher risk of clinical relapse [hazard ratio (HR) = 3·7, 95% confidence interval (CI) = 1·5-9·1 and HR = 2·9, 95% CI = 1·1-8·0, respectively], independently of clinical diagnosis or ANCA specificity. In patients with anti-MPO antibodies, the recurrent ANCA pattern was associated with worsening renal function [odds ratio (OR) = 5·7, 95% CI = 1·2-26·0]. Recurrent or persistent ANCA patterns are associated with a higher risk of clinical relapse. A recurrent ANCA pattern was associated with worsening renal function in anti-MPO-associated vasculitis.
对抗中性粒细胞胞浆抗体（ANCA）相关性血管炎（AAV）患者进行长期观察，可识别出随访过程中 ANCA 水平的不同纵向模式。本研究旨在对这些模式进行特征描述，并确定其预后意义。回顾性分析了在两所大学医院进行的为期 2 年的所有 ANCA 检测。如果患者至少有一次抗髓过氧化物酶（抗-MPO）或抗蛋白酶 3（抗-PR3）抗体高滴度、≥5 次连续 ANCA 检测和经活检或美国风湿病学会（ACR）分类标准诊断的 AAV，则将其纳入分析。将患者的时间进程 ANCA 模式分为单相、缓解、复发或持续。通过单变量和多变量统计分析 ANCA 模式与预后变量（复发率和肾脏结局）之间的关联。共纳入 99 例患者[55 例显微镜下多血管炎（MPA）、36 例肉芽肿性多血管炎（GPA）和 8 例嗜酸性肉芽肿性多血管炎（EGPA）]，中位随访时间为 9 年。在诊断为 MPA 或 GPA 的患者中，复发或持续的 ANCA 模式与更高的临床复发风险相关[风险比（HR）=3.7，95%置信区间（CI）=1.5-9.1 和 HR=2.9，95%CI=1.1-8.0]，独立于临床诊断或 ANCA 特异性。在抗-MPO 抗体阳性的患者中，复发的 ANCA 模式与肾功能恶化相关[比值比（OR）=5.7，95%CI=1.2-26.0]。复发或持续的 ANCA 模式与更高的临床复发风险相关。复发的 ANCA 模式与抗-MPO 相关性血管炎的肾功能恶化相关。
