Potentas-Policewicz Malgorzata, Gawryluk Dariusz, Wiatr Elzbieta, Fijolek Justyna
Department of Geriatrics, Dr Anna Gostynska Wolski Hospital, 01-211 Warsaw, Poland.
Third Department of Pneumonology and Oncology, National Tuberculosis and Lung Diseases Research Institute, 01-138 Warsaw, Poland.
J Clin Med. 2025 Feb 25;14(5):1544. doi: 10.3390/jcm14051544.
: This study compares the clinical features and treatment outcomes of granulomatosis with polyangiitis (GPA) based on age at onset. : A retrospective longitudinal cohort of patients with GPA diagnosed between January 1978 and December 2015 was analyzed, stratified by age at diagnosis: ≤30 years (young group), 31-59 years (middle-aged group), and ≥60 years (older group). The comparative analysis included demographic data, organ involvement, laboratory results, anti-neutrophil cytoplasmic antibody (ANCA) status, comorbidities, treatments, and outcomes. : The analysis included 264 patients newly diagnosed with GPA. Older patients exhibited significantly higher rates of peripheral neuropathy and liver involvement. They had more severe lung diseases and required lung biopsies more frequently. Patients in the middle-aged group exhibited the highest likelihood of severe anemia. Peripheral neuropathy was more common in this group than in younger patients, and their lung disease was less severe than in older patients but more severe than in younger patients. Young patients exhibited mild disease with the least severe lung involvement, mild anemia, and highest albumin levels. Baseline comorbidities and post-treatment adverse events increased significantly with age at diagnosis. Treatment strategies and efficacy were similar across groups, although older patients tended to receive lower initial doses of cyclophosphamide and corticosteroids. : Age at diagnosis influenced GPA clinical characteristics. While the treatment did not vary significantly by age at onset, tailoring therapy to a patient's age is crucial to optimize outcomes and minimize complications.
本研究基于发病年龄比较肉芽肿性多血管炎（GPA）的临床特征和治疗结果。对1978年1月至2015年12月期间诊断为GPA的患者进行回顾性纵向队列分析，根据诊断时的年龄分层：≤30岁（年轻组）、31 - 59岁（中年组）和≥60岁（老年组）。比较分析包括人口统计学数据、器官受累情况、实验室检查结果、抗中性粒细胞胞浆抗体（ANCA）状态、合并症、治疗方法及结果。该分析纳入了264例新诊断为GPA的患者。老年患者外周神经病变和肝脏受累的发生率显著更高。他们患有更严重的肺部疾病，且更频繁地需要进行肺活检。中年组患者严重贫血的可能性最高。外周神经病变在该组比年轻患者更常见，其肺部疾病虽不如老年患者严重，但比年轻患者严重。年轻患者表现为病情较轻，肺部受累最轻，贫血程度较轻且白蛋白水平最高。基线合并症和治疗后不良事件随诊断时年龄的增加而显著增加。尽管老年患者倾向于接受较低初始剂量的环磷酰胺和皮质类固醇，但各年龄组的治疗策略和疗效相似。诊断时的年龄影响GPA的临床特征。虽然治疗方法不会因发病年龄而有显著差异，但根据患者年龄调整治疗方案对于优化治疗结果和减少并发症至关重要。
