伴有嗜酸性粒细胞肉芽肿性多血管炎的胃肠道受累患者的临床特征和长期预后。
Clinical characteristics and long-term outcome of patients with gastrointestinal involvement in eosinophilic granulomatosis with polyangiitis.
机构信息
Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), The Ministry of Education Key Laboratory, Beijing, China.
出版信息
Front Immunol. 2023 Jan 12;13:1099722. doi: 10.3389/fimmu.2022.1099722. eCollection 2022.
OBJECTIVE
This study aims to investigate clinical characteristics, potential risk factors, as well as long-term outcome in EGPA patients with GI involvement.
METHODS
A total of 94 EGPA patients were included in this cohort study. We retrospectively reviewed the clinical data, treatment, and outcome of 21 EGPA patients with GI involvement and compared them with other 73 EGPA patients without GI involvement. Multivariate logistic regression was used to find potential risk factors associated with GI involvement in EGPA patients.
RESULTS
Compared with EGPA patients without GI involvement, EGPA patients with GI involvement had higher level of hs-CRP (65.1 (24.5-138.9) vs. 21.3 (5.7-39.1) mg/L, p=0.005), higher grades of Birmingham vasculitis activity score (BVAS) (20 (13-29.5) vs. 12 (16-19), p=0.022), higher Five Factor Score (FFS) (1 (1-2) vs. 0 (0-1), p<0.001), and were more likely to have weight loss (66.7% vs. 38.4%, p=0.021) at baseline. In EGPA patients with GI involvement, the most common gastrointestinal symptoms were abdominal pain (90.5%) and diarrhea (42.9%). Weight loss was identified as a potential risk factor for GI involvement in EGPA patients (OR = 4.304, 95% CI 1.339-13.841). During follow-up, EGPA patients with GI involvement showed lower 1-year cumulative survival rate (75.2% vs. 100.0%, P <0.0001) and 3-year cumulative survival rate (67.7% vs. 100.0%, P<0.0001), lower long-term remission rate (33.3% vs. 86.3%, P<0.001), but higher 1-year cumulative relapse rate (19.2% vs. 3.8%, P=0.03) and 3-year cumulative relapse rate (54.6% vs. 13.1%, P<0.001) compared with patients without GI involvement.
CONCLUSION
EGPA patients with GI involvement had distinct features from those without GI involvement, including higher hs-CRP level, higher BVAS and FFS scores. EGPA patients with GI involvement showed lower cumulative survival rate, lower long-term remission rate and higher cumulative relapse rate compared with those without GI involvement.
目的
本研究旨在探讨累及胃肠道（GI）的变应性肉芽肿性血管炎（EGPA）患者的临床特征、潜在危险因素及长期预后。
方法
采用回顾性队列研究方法，纳入 94 例 EGPA 患者，其中 21 例存在 GI 受累，73 例无 GI 受累。比较两组患者的临床资料、治疗及转归，并采用多因素 logistic 回归分析确定与 EGPA 患者 GI 受累相关的潜在危险因素。
结果
与无 GI 受累的 EGPA 患者相比，有 GI 受累的 EGPA 患者 hs-CRP 水平更高[65.1（24.5138.9）mg/L 比 21.3（5.739.1）mg/L，P=0.005]，Birmingham 血管炎活动评分（BVAS）更高[20（1329.5）分比 12（1619）分，P=0.022]，5 因子评分（FFS）更高[1（12）分比 0（01）分，P<0.001]，且基线时体重减轻的发生率更高[66.7%比 38.4%，P=0.021]。在有 GI 受累的 EGPA 患者中，最常见的胃肠道症状为腹痛（90.5%）和腹泻（42.9%）。体重减轻是 EGPA 患者 GI 受累的潜在危险因素（OR=4.304，95%CI 1.339~13.841）。随访期间，有 GI 受累的 EGPA 患者 1 年累积生存率[75.2%比 100.0%，P<0.0001]和 3 年累积生存率[67.7%比 100.0%，P<0.0001]更低，长期缓解率[33.3%比 86.3%，P<0.001]更低，但 1 年累积复发率[19.2%比 3.8%，P=0.03]和 3 年累积复发率[54.6%比 13.1%，P<0.001]更高。
结论
与无 GI 受累的 EGPA 患者相比，有 GI 受累的 EGPA 患者具有更高的 hs-CRP 水平、更高的 BVAS 和 FFS 评分等特征。有 GI 受累的 EGPA 患者的累积生存率、长期缓解率更低，累积复发率更高。
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