Department of Renal Medicine, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, UK.
Institute of Immunology and Immunotherapy, University of Birmingham, Cancer Sciences Building, Edgbaston, Birmingham, B15 2TT, UK.
Arthritis Res Ther. 2022 Aug 10;24(1):192. doi: 10.1186/s13075-022-02879-7.
Venous thromboembolism (VTE) is a common complication in patients with anti-neutrophil cytoplasm antibody (ANCA)-associated vasculitides (AAV) and confers significant morbidity and mortality. Both acute and past cytomegalovirus (CMV) infection have been identified as risk factors for VTE in immunocompetent and immunosuppressed individuals. Here, we examine whether past exposure to CMV is a risk factor for VTE amongst patients with AAV.
We retrospectively analysed outcomes of patients with a new diagnosis of AAV from a UK cohort. All confirmed cases of VTE where CMV IgG serology was available were recorded. Retrospective collection of the same data for patients at a North American centre was used as a validation cohort.
VTE was common with 12% of patients from the study cohort (total 259 patients) developing an event during the median follow-up period of 8.5 years of which 60% occurred within the first 12 months following diagnosis. Sixteen percent of CMV seropositive patients developed a VTE compared with 5% of patients who were seronegative (p = 0.007) and CMV seropositivity remained an independent predictor of VTE in multivariable analysis (HR 2.96 [1.094-8.011] p = 0.033). CMV seropositivity at diagnosis was confirmed as a significant risk factor for VTE in the American validation cohort (p = 0.032).
VTE is common in patients with AAV, especially within the first year of diagnosis. Past infection with CMV is an independent risk factor associated with VTE in AAV.
抗中性粒细胞胞质抗体（ANCA）相关性血管炎（AAV）患者常发生静脉血栓栓塞症（VTE），并导致较高的发病率和死亡率。急性和既往巨细胞病毒（CMV）感染已被确定为免疫功能正常和免疫抑制个体发生 VTE 的危险因素。在此，我们研究既往 CMV 感染是否是 AAV 患者发生 VTE 的危险因素。
我们回顾性分析了来自英国队列的新诊断为 AAV 的患者的结局。记录了所有有明确 VTE 诊断且 CMV IgG 血清学检查结果可用的病例。回顾性收集北美中心相同数据的患者作为验证队列。
VTE 较为常见，研究队列中有 12%（共 259 例患者）的患者在中位 8.5 年的随访期间发生了事件，其中 60%的事件发生在诊断后的前 12 个月内。CMV 血清阳性患者中有 16%发生了 VTE，而血清阴性患者中只有 5%发生了 VTE（p = 0.007），且在多变量分析中 CMV 血清阳性仍然是 VTE 的独立预测因素（HR 2.96 [1.094-8.011]，p = 0.033）。CMV 血清阳性在诊断时被确认为美国验证队列中 VTE 的显著危险因素（p = 0.032）。
AAV 患者中 VTE 较为常见，尤其是在诊断后的前 1 年内。既往 CMV 感染是与 AAV 相关的 VTE 的独立危险因素。
