Vasculitis Clinic, Mount Sinai Hospital, Department of Rheumatology, University of Toronto, Toronto, Ontario, Canada.
Vasculitis Clinic, Mount Sinai Hospital, Department of Rheumatology, University of Toronto, Toronto, Ontario, Canada.
Semin Arthritis Rheum. 2021 Oct;51(5):1011-1015. doi: 10.1016/j.semarthrit.2021.07.013. Epub 2021 Jul 25.
To determine the predictive value of disease characteristics at 12-month follow-up after the diagnosis of GPA for subsequent relapses in a cohort of patients followed at a tertiary vasculitis clinic.
Demographic, clinical, and biological data at diagnosis and during follow-up from patients with GPA followed for at least 24 months at the Mount Sinai Hospital Vasculitis Clinic in Toronto, Canada were extracted from the Canadian Vasculitis Research Network (CanVasc) database and analyzed. The association between ANCA status and type (PR3- or MPO-ANCA), presence of microscopic hematuria, or serum creatinine level at follow-up month 12 ± 3 (M12) and relapses after M12 were assessed using Cox proportional hazard models.
A total of 113 GPA patients were included in this study (50 ANCA positive, 63 ANCA negative at M12). Patient demographics and disease characteristics were similar at diagnosis, including the treatments used for induction and at M12. The global 5-year relapse rate was 55.8%, without any difference in the relapse rates after M12 between those ANCA-positive or negative at M12. However, in multivariate analyses, MPO-ANCA positivity at M12 was predictive of increased relapses after M12 (hazard ratio [HR] 3.54, P=0.01), as was the presence of microhematuria at M12 (HR 1.91, P=0.04). In contrast, higher serum creatinine levels at M12 were associated with a decreased risk of subsequent relapse (HR 0.99, P=0.04).
In this cohort of patients with GPA, MPO-ANCA positivity and persistent microscopic hematuria at M12 were associated with increased risk of subsequent relapse, and could thus have value to predict disease outcome during follow-up.
确定 GPA 患者在诊断后 12 个月随访时疾病特征对后续复发的预测价值，该队列患者在加拿大多伦多西奈山医院血管炎诊所接受了至少 24 个月的随访。
从加拿大血管炎研究网络（CanVasc）数据库中提取了在加拿大多伦多西奈山医院血管炎诊所接受随访至少 24 个月的 GPA 患者的人口统计学、临床和生物学数据，并进行了分析。采用 Cox 比例风险模型评估 12 个月时（M12）抗中性粒细胞胞质抗体（ANCA）状态和类型（PR3-或 MPO-ANCA）、镜下血尿和血清肌酐水平与 M12 后复发之间的关系。
本研究共纳入 113 例 GPA 患者（50 例 MPO-ANCA 阳性，63 例 MPO-ANCA 阴性）。患者在诊断时的人口统计学和疾病特征相似，包括诱导治疗和 M12 时的治疗方法。总的 5 年复发率为 55.8%，在 M12 时 MPO-ANCA 阳性或阴性患者的复发率没有差异。然而，在多变量分析中，M12 时 MPO-ANCA 阳性与 M12 后复发增加相关（风险比 [HR] 3.54，P=0.01），M12 时镜下血尿存在也是如此（HR 1.91，P=0.04）。相比之下，M12 时血清肌酐水平较高与随后复发风险降低相关（HR 0.99，P=0.04）。
在本 GPA 患者队列中，M12 时 MPO-ANCA 阳性和持续镜下血尿与后续复发风险增加相关，因此可能对预测随访期间的疾病结局有价值。
