Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; and.
Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Kidney360. 2020 Mar 3;1(4):258-262. doi: 10.34067/KID.0000572019. eCollection 2020 Apr 30.
The incidence of venous thromboembolism (VTE) is increased in ANCA-associated vasculitis (AAV). We assessed the frequency of VTE observed among patients with AAV evaluated at our center and identified risk factors.
Patients from the Johns Hopkins Vasculitis Center cohort who were evaluated between 1998 and 2018 and had a diagnosis of granulomatosis with polyangiitis (GPA) or microscopic polyangiitis (MPA) were eligible for analysis. Baseline demographics and clinical and serologic data were extracted. Univariate and multivariate analyses were performed to identify factors associated with VTE in AAV.
A total of 162 patients with AAV were identified, 105 (65%) with GPA; 22 (14%) of these patients had a recorded VTE with a median time to VTE of 1 month. The mean (SD) age in the VTE versus non-VTE groups was 54±20 versus 55±17 years (=0.99), 64% versus 60% female (=0.93), 82% versus 49% PR3-ANCA positive (=0.01), with a total mean BMI of 33.3±5.7 versus 28.3±6.1 kg/m, (<0.001) respectively. The median Birmingham Vasculitis Activity Score (BVAS version 3) was 19 versus 14 (=0.02). Univariate analyses identified PR3-ANCA, rapidly progressive GN (RPGN), and hypoalbuminemia. In multivariate analysis, the significant associations with VTE included PR3-ANCA (OR, 4.77; =0.02), hypoalbuminemia (OR, 4.84; =0.004), and BMI (OR, 1.18; <0.001).
VTE is a surprisingly common complication of AAV. PR3-ANCA and hypoalbuminemia are risk factors for developing VTEs. Further studies are needed to confirm these findings.
This article contains a podcast at https://www.asn-online.org/media/podcast/K360/2020_04_30_KID0000572019.mp3.
抗中性粒细胞胞浆抗体（ANCA）相关性血管炎（AAV）患者的静脉血栓栓塞（VTE）发生率增加。我们评估了在我院接受评估的 AAV 患者中观察到的 VTE 发生率，并确定了危险因素。
1998 年至 2018 年间，我们从约翰霍普金斯血管炎中心队列中选择了符合条件的患者，这些患者被诊断为肉芽肿性多血管炎（GPA）或显微镜下多血管炎（MPA）。提取基线人口统计学和临床及血清学数据。进行单因素和多因素分析，以确定与 AAV 中 VTE 相关的因素。
共纳入 162 例 AAV 患者，其中 105 例（65%）为 GPA；其中 22 例（14%）患者记录到 VTE，VTE 的中位时间为 1 个月。VTE 组和非 VTE 组的平均（SD）年龄分别为 54±20 岁和 55±17 岁（=0.99），64%和 60%为女性（=0.93），82%和 49%为 PR3-ANCA 阳性（=0.01），平均 BMI 分别为 33.3±5.7kg/m2 和 28.3±6.1kg/m2（<0.001）。中位伯明翰血管炎活动评分（BVAS 第 3 版）分别为 19 分和 14 分（=0.02）。单因素分析确定 PR3-ANCA、快速进行性肾小球肾炎（RPGN）和低白蛋白血症。多因素分析显示，与 VTE 相关的显著因素包括 PR3-ANCA（OR，4.77；=0.02）、低白蛋白血症（OR，4.84；=0.004）和 BMI（OR，1.18；<0.001）。
VTE 是 AAV 的一种令人惊讶的常见并发症。PR3-ANCA 和低白蛋白血症是发生 VTE 的危险因素。需要进一步的研究来证实这些发现。
本文包含一个播客，网址为 https://www.asn-online.org/media/podcast/K360/2020_04_30_KID0000572019.mp3。
