Ueda Yoshitaka, Nunokawa Takahiro, Takamasu Eisuke, Okada Haruka, Shimada Kota, Yokogawa Naoto
Department of Rheumatic Diseases, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8524, Japan.
Department of Rheumatic Diseases, Tama-Nambu Chiiki Hospital, Tokyo, Japan.
Clin Rheumatol. 2025 Jan;44(1):377-384. doi: 10.1007/s10067-024-07277-9. Epub 2024 Dec 16.
Several studies have examined the utility of quadriceps femoris muscle biopsies for diagnosing antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). We aimed to investigate the effects of glucocorticoid therapy on the muscle biopsy findings of patients with AAV. Data from patients with AAV who underwent a biopsy of the bilateral vastus lateralis of the quadriceps femoris at Tokyo Metropolitan Tama Medical Center between January 2015 and December 2023 were retrospectively analyzed. In total, 126 patients with suspected small vessel vasculitis (SVV) or medium vessel vasculitis (MVV) underwent a muscle biopsy at the study center. Of these, the present study included 71 patients with a final diagnosis of AAV who received a muscle biopsy of the bilateral vastus lateralis at disease onset and began glucocorticoid therapy at the study center. Of the 71 patients, 41 (57.7%) had a positive muscle biopsy finding as defined by the presence of inflammatory infiltrates with fibrinoid necrosis in the vessels. Fifty-six and 15 patients underwent a biopsy before and after starting glucocorticoid therapy, respectively. Of the former, 33 (58.9%) had a positive finding compared to eight (53.3%) of the latter (Pearson's chi-square test: p = 0.697). Among the patients with a positive biopsy result, 22 (53.7%) and 19 (46.3%) had a unilaterally and bilaterally positive finding, respectively. Glucocorticoid therapy did not significantly affect the findings of quadriceps femoris muscle biopsies. Unilateral biopsies may have a lower diagnostic sensitivity for AAV than bilateral biopsies.
多项研究探讨了股四头肌活检在诊断抗中性粒细胞胞浆抗体（ANCA）相关血管炎（AAV）中的作用。我们旨在研究糖皮质激素治疗对AAV患者肌肉活检结果的影响。对2015年1月至2023年12月期间在东京都多摩医疗中心接受双侧股外侧肌活检的AAV患者的数据进行了回顾性分析。共有126例疑似小血管血管炎（SVV）或中血管血管炎（MVV）的患者在研究中心接受了肌肉活检。其中，本研究纳入了71例最终诊断为AAV的患者，这些患者在疾病发作时接受了双侧股外侧肌活检，并在研究中心开始接受糖皮质激素治疗。在这71例患者中，41例（57.7%）的肌肉活检结果呈阳性，定义为血管内存在伴有纤维蛋白样坏死的炎性浸润。分别有56例和15例患者在开始糖皮质激素治疗之前和之后接受了活检。前者中有33例（58.9%）结果呈阳性，而后者中有8例（53.3%）结果呈阳性（Pearson卡方检验：p = 0.697）。在活检结果呈阳性的患者中，分别有22例（53.7%）和19例（46.3%）为单侧阳性和双侧阳性。糖皮质激素治疗对股四头肌活检结果没有显著影响。单侧活检对AAV的诊断敏感性可能低于双侧活检。
