Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Republic of Korea.
Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
Clin Rheumatol. 2022 Nov;41(11):3429-3437. doi: 10.1007/s10067-022-06267-z. Epub 2022 Jul 9.
INTRODUCTION/OBJECTIVES: Birmingham vasculitis activity score (BVAS) version 3 (BVAS 3.0) and BVAS/granulomatosis with polyangiitis (BVAS/GPA) are used as indicators of disease activity in anti-neutrophil cytoplasmic antibody-associated vasculitis. We evaluated the association between these indices and the significance in patients with GPA and microscopic polyangiitis (GPA/MPA).
We retrospectively reviewed the records of 203 patients with GPA/MPA in our hospital. The correlation between BVAS 3.0 and BVAS/GPA with the five-factor score (FFS) and laboratory data was investigated. The episodes of all-cause mortality, end-stage renal disease, and disease relapse were counted as adverse clinical outcomes. Multivariate Cox hazard analyses were performed to assess the relationships between both indices and patient outcomes.
Sixty-five (32.0%) and 138 (68.0%) patients with GPA and MPA were included. The median BVAS 3.0 was significantly higher in patients with MPA than in those with GPA (13.0 vs. 11.0, p = 0.015), whereas BVAS/GPA was higher in patients with GPA (4.0 vs. 3.0, p = 0.001). BVAS 3.0 and BVAS/GPA correlated significantly (r = 0.670, p < 0.001); both BVAS 3.0 and BVAS/GPA were shown to be associated with the outcomes investigated in separate Cox models. However, the correlation between BVAS 3.0 and BVAS/GPA was especially higher in a subgroup of patients with MPA than in those with GPA (MPA: r = 0.817, p < 0.001 vs. GPA: r = 0.570, p < 0.001) and with renal involvement (r = 0.676, p < 0.001).
Although both BVAS 3.0 and BVAS/GPA significantly correlated and predicted outcomes well in those with GPA/MPA, a discord was observed based on disease subtypes and organ involvement. Key Points • BVAS 3.0 and BVAS/GPA significantly correlated and predicted outcomes in those with GPA/MPA. • A discordance was also observed based on disease subtypes and organ involvement.
介绍/目的：伯明翰血管炎活动评分（BVAS）第 3 版（BVAS 3.0）和 BVAS/肉芽肿性多血管炎（BVAS/GPA）用于衡量抗中性粒细胞胞浆抗体相关性血管炎的疾病活动度。我们评估了这些指标与 GPA 和显微镜下多血管炎（GPA/MPA）患者的相关性及其意义。
我们回顾性分析了我院 203 例 GPA/MPA 患者的病历。研究了 BVAS 3.0 和 BVAS/GPA 与五因素评分（FFS）和实验室数据之间的相关性。将所有原因死亡率、终末期肾病和疾病复发的发作次数计为不良临床结局。进行多变量 Cox 风险分析评估这两个指标与患者结局的关系。
65（32.0%）例 GPA 和 138（68.0%）例 MPA 患者纳入研究。MPA 患者的中位 BVAS 3.0 明显高于 GPA 患者（13.0 比 11.0，p=0.015），而 GPA 患者的 BVAS/GPA 较高（4.0 比 3.0，p=0.001）。BVAS 3.0 和 BVAS/GPA 显著相关（r=0.670，p<0.001）；在单独的 Cox 模型中，BVAS 3.0 和 BVAS/GPA 均与所研究的结局相关。然而，在 MPA 患者亚组中，BVAS 3.0 和 BVAS/GPA 之间的相关性明显高于 GPA 患者（MPA：r=0.817，p<0.001 比 GPA：r=0.570，p<0.001），与肾脏受累（r=0.676，p<0.001）的相关性也较高。
尽管在 GPA/MPA 患者中，BVAS 3.0 和 BVAS/GPA 均显著相关并能很好地预测结局，但根据疾病亚型和器官受累情况，仍存在差异。
• BVAS 3.0 和 BVAS/GPA 在 GPA/MPA 患者中显著相关并预测结局。
• 根据疾病亚型和器官受累情况，存在差异。
