Moiseev Sergey, Kronbichler Andreas, Makarov Egor, Bulanov Nikolay, Crnogorac Matija, Direskeneli Haner, Galesic Kresimir, Gazel Ummugulsum, Geetha Duvuru, Guillevin Loic, Hrušková Zdenka, Little Mark A, Ahmed Adeel, McAdoo Stephen P, Mohammad Aladdin J, Moran Sarah, Novikov Pavel, Pusey Charles D, Rahmattulla Chinar, Satrapová Veronika, Silva Joana, Terrier Benjamin, Tesař Vladimír, Westman Kerstin, Jayne David R W
Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University.
Faculty of Medicine, Lomonosov Moscow State University, Moscow, Russia.
Rheumatology (Oxford). 2021 Oct 2;60(10):4654-4661. doi: 10.1093/rheumatology/keab071.
To investigate the occurrence of venous thromboembolic events (VTE) in a large cohort of patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) across the European Union, Turkey, Russia, UK and North America.
Patients with a definite diagnosis of AAV who were followed for at least 3 months and had sufficient documentation were included. Data on VTE, including either deep vein thrombosis or pulmonary embolism, were collected retrospectively from tertiary vasculitis centres. Univariate and multivariate regression models were used to estimate odds ratios (ORs) and 95% CIs.
Over a median follow-up of 63 (interquartile range: 29, 101) months, VTE occurred in 278 (9.7%) of 2869 AAV patients with a similar frequency across different countries (from 6.3% to 13.7%), and AAV subtype [granulomatosis with polyangiitis: 9.8% (95% CI: 8.3, 11.6%); microscopic polyangiitis: 9.6% (95% CI: 7.9, 11.4%); and eosinophilic granulomatosis with polyangiitis: 9.8% (95% CI: 7.0, 13.3%)]. Most VTE (65.6%) were reported in the first-year post-diagnosis. Multiple factor logistic regression analysis adjusted for sex and age showed that skin (OR 1.71, 95% CI: 1.01, 2.92), pulmonary (OR 1.78, 95% CI: 1.04, 3.14) and kidney [eGFR 15-60 ml/min/1.73 m2, OR 2.86 (95% CI: 1.27, 6.47); eGFR <15 ml/min/1.73 m2, OR 6.71 (95% CI: 2.94, 15.33)] involvement were independent variables associated with a higher occurrence of VTE.
Two-thirds of VTE occurred during the initial phase of active disease. We confirmed previous findings from smaller studies that a decrease in kidney function, skin involvement and pulmonary disease are independently associated with VTE.
调查在欧盟、土耳其、俄罗斯、英国和北美的一大群抗中性粒细胞胞浆抗体（ANCA）相关血管炎（AAV）患者中静脉血栓栓塞事件（VTE）的发生情况。
纳入确诊为AAV且随访至少3个月并有充分记录的患者。从三级血管炎中心回顾性收集VTE数据，包括深静脉血栓形成或肺栓塞。使用单变量和多变量回归模型估计比值比（OR）及95%置信区间（CI）.
在中位随访63（四分位间距：29，101）个月期间，2869例AAV患者中有278例（9.7%）发生VTE，不同国家的发生率相似（从6.3%至13.7%），且AAV亚型[肉芽肿性多血管炎：9.8%（95%CI：8.3,11.6%）；显微镜下多血管炎：9.6%（95%CI：7.9,11.4%）；嗜酸性肉芽肿性多血管炎：9.8%（95%CI：7.0,13.3%）]。大多数VTE（65.6%）在确诊后的第一年内报告。经性别和年龄校正的多因素逻辑回归分析显示，皮肤（OR 1.71，95%CI：1.01,2.92）、肺部（OR 1.78，95%CI：1.04,3.14）和肾脏[估算肾小球滤过率（eGFR）15 - 60 ml/min/1.73 m2，OR 2.86（95%CI：1.27,6.47）；eGFR <15 ml/min/1.73 m2，OR 6.71（95%CI：2.94,15.33）]受累情况均为与VTE发生率较高相关的独立变量。
三分之二的VTE发生在疾病活动的初始阶段.我们证实先前较小规模研究的结果，即肾功能下降、皮肤受累和肺部疾病均与VTE独立相关。
