Whang Jeong Yeop, Ha Jang Woo, Park Yong-Beom, Lee Sang-Won
Department of Medicine, Yonsei University College of Medicine, Seoul 03722, Republic of Korea.
Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul 03722, Republic of Korea.
J Clin Med. 2024 Sep 29;13(19):5831. doi: 10.3390/jcm13195831.
We applied the 2022 American College of Rheumatology/ European Alliance of Association for Rheumatology (ACR/EULAR) criteria for antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) to patients histologically diagnosed with lupus nephritis (LN) to investigate the overall rate of and initial contributing factors to the reclassification of overlap syndrome of LN with AAV (OS-LN-AAV). We retrospectively reviewed the medical records of 1292 patients with systemic lupus erythematosus (SLE) and included 164 patients with LN in this study. Patient demographics, SLE manifestations, LN classes, and laboratory data, including ANCA levels, were recorded. All-cause mortality and end-stage kidney disease (ESKD) were evaluated as poor outcomes. The median age of the 164 patients was 37.0 years, and 12.2% were men. The overall reclassification rate was 37.8%, of which 34.1% and 3.7% of the patients were reclassified as having OS-LN-microscopic polyangiitis and OS-LN-granulomatosis with polyangiitis (GPA), respectively, but none as having eosinophilic GPA. ANCA positivity and AAV-suggesting lung lesions were major contributors to OS-LN-AAV reclassification. When patients were compared based on OS-LN AAV reclassification, ANCA positivity and myeloperoxidase-ANCA (or P-ANCA) positivity favoured for OS-LN-AAV reclassification, whereas oral ulcers did not. However, OS-LN-AAV reclassification did not affect all-cause mortality or ESKD. This is the first study demonstrating a 37.8% reclassification rate in patients histologically diagnosed with LN using the 2022 ACR/EULAR criteria for AAV. Furthermore, it was also the first to reveal ANCA positivity and AAV-suggesting lung lesions as major contributors to OS-LN-AAV reclassification.
我们将2022年美国风湿病学会/欧洲抗风湿病联盟（ACR/EULAR）抗中性粒细胞胞浆抗体（ANCA）相关血管炎（AAV）的诊断标准应用于经组织学诊断为狼疮性肾炎（LN）的患者，以调查LN与AAV重叠综合征（OS-LN-AAV）的总体重新分类率及初始促成因素。我们回顾性分析了1292例系统性红斑狼疮（SLE）患者的病历，并纳入本研究中的164例LN患者。记录患者的人口统计学信息、SLE表现、LN分型以及包括ANCA水平在内的实验室数据。将全因死亡率和终末期肾病（ESKD）评估为不良结局。164例患者的中位年龄为37.0岁，男性占12.2%。总体重新分类率为37.8%，其中分别有34.1%和3.7%的患者被重新分类为患有OS-LN-显微镜下多血管炎和OS-LN-肉芽肿性多血管炎（GPA），但无患者被重新分类为嗜酸性GPA。ANCA阳性和提示AAV的肺部病变是OS-LN-AAV重新分类的主要促成因素。当根据OS-LN AAV重新分类对患者进行比较时，ANCA阳性和髓过氧化物酶-ANCA（或P-ANCA）阳性有利于OS-LN-AAV重新分类，而口腔溃疡则不然。然而，OS-LN-AAV重新分类并不影响全因死亡率或ESKD。这是第一项使用2022年ACR/EULAR的AAV诊断标准，证明经组织学诊断为LN的患者重新分类率为37.8%的研究。此外，这也是第一项揭示ANCA阳性和提示AAV的肺部病变是OS-LN-AAV重新分类主要促成因素的研究。
