Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul 03722, Republic of Korea.
Department of Medical Science, BK21 Plus Project, Yonsei University College of Medicine, Seoul 03722, Republic of Korea.
Medicina (Kaunas). 2024 Oct 7;60(10):1639. doi: 10.3390/medicina60101639.
Glial fibrillary acidic protein (GFAP) is a type III intermediate filament protein primarily produced by cells in the central nervous system (CNS) and other major organs such as the kidneys. This study investigated whether serum GFAP could be used to estimate cross-sectional vasculitis activity presented via the Birmingham vasculitis activity score (BVAS) in patients with antineutrophil cytoplasmic antibody-associated vasculitis (AAV). This study included 74 patients with AAV. Clinical and laboratory data at diagnosis including BVAS and C-reactive protein (CRP) were reviewed. During follow-up, all-cause mortality and end-stage kidney disease (ESKD) were considered poor outcomes. Serum GFAP was measured from sera collected and stored at diagnosis. The median age of the 74 patients was 63.5 years. Serum GFAP was inversely correlated with the cross-sectional BVAS (r = -0.373) and CRP (r = -0.320). It was also significantly correlated with general (r = -0.237) and renal (r = -0.335) manifestations among BVAS systemic items, and furthermore, among minor items of renal manifestation, correlating with sum scores for proteinuria (r = -0.409) and haematuria (r = -0.305). Additionally, compared with patients with serum GFAP > 194.9 pg/mL, those with serum GFAP ≤ 194.9 pg/mL showed a higher risk for progression to ESKD (relative risk 3.150) and a significantly lower cumulative ESKD-free survival rate. This study demonstrated the clinical potential of serum GFAP at diagnosis for predicting not only cross-sectional vasculitis activity through the anticipation of the extent of renal involvement but also future progression to ESKD in patients with AAV.
胶质纤维酸性蛋白（GFAP）是一种 III 型中间丝蛋白，主要由中枢神经系统（CNS）和其他主要器官（如肾脏）的细胞产生。本研究探讨了血清 GFAP 是否可用于估计抗中性粒细胞胞质抗体相关性血管炎（AAV）患者的 Birmingham 血管炎活动评分（BVAS）所呈现的横断面血管炎活动。本研究纳入了 74 例 AAV 患者。回顾了诊断时的临床和实验室数据，包括 BVAS 和 C 反应蛋白（CRP）。在随访期间，全因死亡率和终末期肾病（ESKD）被认为是不良结局。从诊断时采集和储存的血清中测量了血清 GFAP。74 例患者的中位年龄为 63.5 岁。血清 GFAP 与横断面 BVAS（r = -0.373）和 CRP（r = -0.320）呈负相关。它还与 BVAS 全身项目中的一般（r = -0.237）和肾脏（r = -0.335）表现显著相关，此外，在肾脏表现的次要项目中，与蛋白尿（r = -0.409）和血尿（r = -0.305）的总分相关。此外，与血清 GFAP > 194.9 pg/mL 的患者相比，血清 GFAP ≤ 194.9 pg/mL 的患者进展为 ESKD 的风险更高（相对风险 3.150），且累积无 ESKD 生存率显著降低。本研究表明，诊断时血清 GFAP 的临床潜力不仅可预测横断面血管炎活动，通过预测肾脏受累程度，还可预测 AAV 患者未来进展为 ESKD。
