Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
Division of Rheumatology, Department of Internal Medicine, and Institute for Immunology and Immunological Diseases, Yonsei University College of Medicine, Seoul, Republic of Korea.
Clin Exp Rheumatol. 2024 Apr;42(4):887-894. doi: 10.55563/clinexprheumatol/jui6xj. Epub 2024 Mar 22.
We investigated whether first-year cumulative myeloperoxidase (MPO)-antineutrophil cytoplasmic antibody (ANCA) and proteinase 3 (PR3)-ANCA titres were associated with all-cause mortality and relapse during follow-up in patients with microscopic polyangiitis (MPA) and granMETHODS: Altogether, 74 patients with MPA and 40 with GPA were included in this study. Their clinical data at diagnosis were collected. First-year cumulative ANCA titres were defined as the area under the curve (AUC) of ANCA titres during the first year after MPA or GPA diagnosis, which was obtained using the trapezoidal rule. All-cause mortality and relapse were considered poor outcomes of MPA and GPA.
The median ages of patients with MPA and GPA were 65.5 and 60.5 years, respectively. No significant correlation was observed between ANCA titres at diagnosis and concurrent MPA and GPA activity or the inflammatory burden. First-year cumulative MPO-ANCA titres exhibited a significant AUC for all-cause mortality during follow-up in patients with MPA. The optimal cut-off of first-year cumulative MPO-ANCA titres for all-cause mortality was determined as 720.8 IU/mL using receiver operating characteristic curve analysis. MPA patients with first-year cumulative MPO-ANCA titres ≥720.8 IU/mL exhibited a significantly higher risk for all-cause mortality than those without (relative risk 13.250). Additionally, MPA patients with first-year cumulative MPO-ANCA titres ≥720.8 IU/mL exhibited a significantly lower cumulative patients' survival rate than those without.
This is the first study to demonstrate the association between first-year cumulative MPO-ANCA titres and all-cause mortality during follow-up in patients with MPA.
我们研究了在显微镜下多血管炎（MPA）和肉芽肿性多血管炎（GPA）患者中，第一年累积髓过氧化物酶（MPO）-抗中性粒细胞胞质抗体（ANCA）和蛋白酶 3（PR3）-ANCA 滴度与随访期间的全因死亡率和复发率之间是否存在关联。
本研究共纳入 74 例 MPA 患者和 40 例 GPA 患者。收集了他们诊断时的临床数据。第一年累积 ANCA 滴度定义为 MPA 或 GPA 诊断后第一年 ANCA 滴度的曲线下面积（AUC），使用梯形法则获得。全因死亡率和复发被认为是 MPA 和 GPA 的不良结局。
MPA 和 GPA 患者的中位年龄分别为 65.5 岁和 60.5 岁。在 MPA 和 GPA 活动或炎症负担方面，诊断时的 ANCA 滴度与同期无显著相关性。在 MPA 患者中，第一年累积 MPO-ANCA 滴度与随访期间的全因死亡率具有显著的 AUC。使用受试者工作特征曲线分析确定，第一年累积 MPO-ANCA 滴度的最佳截断值为 720.8 IU/mL，用于全因死亡率。第一年累积 MPO-ANCA 滴度≥720.8 IU/mL 的 MPA 患者全因死亡率的风险显著高于滴度＜720.8 IU/mL 的患者（相对风险 13.250）。此外，第一年累积 MPO-ANCA 滴度≥720.8 IU/mL 的 MPA 患者的累积生存率显著低于滴度＜720.8 IU/mL 的患者。
这是第一项表明在 MPA 患者中，第一年累积 MPO-ANCA 滴度与随访期间全因死亡率之间存在关联的研究。
