诊断时伴有/不伴有感染的抗中性粒细胞胞浆抗体相关性血管炎患儿的临床病理特征比较
Comparison of the clinicopathological characteristics of children with anti-neutrophil cytoplasmic antibody-associated vasculitis with/without infection at diagnosis.
作者信息
Long Li-Li, Tan Mei, Deng Hui, Tang Hui, Lin Xiao-Qing, Zhang Miao, Deng Hui-Ying, Gao Xia
机构信息
Department of Nephrology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, China.
出版信息
BMC Nephrol. 2025 Jan 6;26(1):7. doi: 10.1186/s12882-024-03919-x.
BACKGROUND
Infectious episodes contribute to morbidity and mortality in patients with anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). Renal involvement, also known as ANCA-associated glomerulonephritis (AGN), is frequently observed in AAV. Little is known about whether co-infection at initial diagnosis is associated with renal outcome and prognosis in children with AGN.
METHODS
Clinical and prognostic data for children admitted to our center with AAV from January 2001 to August 2023 were analyzed retrospectively. We compared the incidence of end-stage renal disease (ESRD) and mortality according to infection status at initial diagnosis.
RESULTS
A total of 33 children with AGN were included in this study, 22 had an infection at the time of AGN diagnosis. A trend toward higher levels of proteinuria in the infected group than in the non-infected group was observed (p = 0.42). Patients in the infected group had higher creatinine and lower eGFR values than those in the non-infected group (p = 0.09). A significant decrease in HGB was observed in the infected group (p < 0.05). There were no significant differences in the baseline values of ALB and complement c3 between the two groups. A similar proportion of patients in both groups required dialysis at the time of diagnosis (27.3% vs. 31.8%). Patients with infection presented with significantly greater ESR and CRP levels (p < 0.05), and the most commonly infected site was the lung. After 6 months of treatment, compared with those in the non-infected group, the median levels of creatinine and proteinuria were higher in the infected group. Besides, lower levels of eGFR and ALB were also observed in the infected group. 5 (45.5%) and 13 (59.1%) patients died or progressed to ESRD, respectively, in the non-infected group and infected group at the last follow-up.
CONCLUSIONS
Infection at initial diagnosis does not affect the outcomes of children with AGN, although it could lead to a reduction in kidney function.
背景
感染发作会导致抗中性粒细胞胞浆抗体（ANCA）相关血管炎（AAV）患者的发病率和死亡率。肾脏受累，也称为ANCA相关肾小球肾炎（AGN），在AAV中经常出现。关于初诊时合并感染是否与AGN儿童的肾脏结局和预后相关，目前知之甚少。
方法
回顾性分析2001年1月至2023年8月在本中心收治的AAV患儿的临床和预后数据。我们根据初诊时的感染状况比较了终末期肾病（ESRD）的发生率和死亡率。
结果
本研究共纳入33例AGN患儿，其中22例在AGN诊断时有感染。观察到感染组的蛋白尿水平有高于非感染组的趋势（p = 0.42）。感染组患者的肌酐水平较高，估算肾小球滤过率（eGFR）值较低，高于非感染组（p = 0.09）。感染组的血红蛋白（HGB）显著下降（p < 0.05）。两组间白蛋白（ALB）和补体c3的基线值无显著差异。两组中相似比例的患者在诊断时需要透析（27.3%对31.8%）。感染患者的血沉（ESR）和C反应蛋白（CRP）水平显著更高（p < 0.05），最常感染的部位是肺部。治疗6个月后，与非感染组相比，感染组的肌酐和蛋白尿中位数水平更高。此外，感染组的eGFR和ALB水平也较低。在最后一次随访时，非感染组和感染组分别有5例（45.5%）和13例（59.1%）患者死亡或进展为ESRD。
结论
初诊时的感染虽可能导致肾功能下降，但不影响AGN儿童的预后。
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