呼吸系统抗中性粒细胞胞浆抗体相关性血管炎的预后和危险因素

Analysis of the prognosis and risk factors of respiratory ANCA-associated vasculitis

目的：评价呼吸系统抗中性粒细胞胞浆抗体（ANCA）相关性血管炎（AAV）的预后，并分析与预后相关的危险因素。方法回顾性收集45名就诊于中国医科大学呼吸疾病研究所的AVV患者的临床资料。计算患者的1年死亡率，并对可能与这一预后相关的因素进行逻辑回归分析。结果患者的1年死亡率为17.8％（8/45）。主要死亡原因为肺部感染、弥漫性肺泡出血和呼吸衰竭。年龄＞65岁的患者1年内死亡风险显著增高，OR值为6.63（P＝0.025，95％CI 2.56～55.11），显微镜下多血管炎的 OR 值为1.6（P＝0.03，95％CI 1.08～4.98），呼吸衰竭的 OR 值为5.5（P＝0.044，95％CI 1.9～45.72），急性肾衰竭的OR值为8.14（P＝0.032，95％CI 3.22～61.14）。结论即使接受积极的治疗，呼吸系统AAV患者的死亡率仍然很高，高龄、显微镜下多血管炎、呼吸衰竭和急性肾衰竭是死亡的主要危险因素。

Objective To evaluate the prognosis of respiratory ANCA-associated vasculitis , then analyze the risk factors related to this prognosis.Methods The clinical data of 45 respiratory ANCA-associated vasculitis patients were retrospectively collected.The one-year mortality of these patients was calculated.Then those factors probably related to this prognosis were analyzed by logistic regression analy -sis.Results The one-year mortality was 17.8%(8/45).The major causes of death were pulmonary infection , diffuse alveolar hemorrhage and respiratory failure.Patients older than 65 had high risk for death, the OR value was 6.63(P=0.025,95%CI 2.56~55.11),the OR value for microscopic polyangitis was 1.6(P=0.03,95%CI 1.08~4.98),the OR value for respiratory failure was 5.5(P=0.044,95% CI 1.9~45.72 ) ,and the OR value for renal failure was 8.14 ( P=0.032 ,95% CI 3.22~61.14 ).Conclusions Even with standard treat-ment , the mortality of respiratory ANCA-associated vasculitis is still high.Advanced age , microscopic polyangitis , respiratory failure and re-nal failure are the major risk factors for the death of patients.