肾脏受累为主的抗中性粒细胞胞质抗体相关性血管炎患者的预后及其相关危险因素分析

Outcome and risk factors, for renal involvement in patients with anti-neutrophil cytoplasmic antibody associated vasculitis

目的探讨肾脏受累为主的抗中性粒细胞胞质抗体（ANCA）相关性血管炎患者的预后及其影响因素。方法对2006--2008年我院诊断的64例肾脏受累为主的ANCA相关性血管炎患者进行回顾性分析，并对其进行前瞻性随访，使用Logistic回归、Cox回归等分析与患者肾脏预后有关的危险因素。结果①共入选64例患者，其中男性40例，女性24例，平均年龄（59．9±2．0）岁。随访21。55个月，平均（38±16）个月，期间34例（53％）患者出现死亡或进入长期肾脏替代治疗。②预后不同的2组患者起病时血肌酐[分别为（6±246）、（245±127）μmol／L，t=7．17，P=0．005]、红细胞沉降率（ESR）[分别为（112±24）、（76±48）mm／1h，t=3．74，P〈0．01]、血浆自蛋白[分别为（294±31）、（316±42）g/L，t=-2．27，P=O．01]、血红蛋白[分别为（79±13）、（99±33）g/L，t=-3．23，P〈0．01]差异均有统计学意义。Logistie回归及Cox回归分析证实起病时血肌酐[β=1．004，95％可信区间（CI）1．002～1．006，P〈0．01]及ESR[β=1．018，95％CI1．000～1．037，P=0．046]是预测患者预后的独立危险因素。③ROC曲线结果显示起病时血肌酐和ESR曲线下面积分别为0．95，0．80．敏感性均为94％，特异性分别为93％和70％。结论以肾脏受累为主的ANCA相关性血管炎患者预后差，起病时血肌酐水平和ESR可能是判断患者预后的重要影响因素。

Objective To investigate the outcome and risk factors for kidney involvement by analyzing 64 patients with anti-neutrophil cytoplasmic antibody （ANCA）-associated vasculitis. Methods Data analy- zed including the demographic information, survival status, renal survival status and laboratory parameters such as serum albumin level, serum creatinine level, urinary protein excretion level, hematuria, high sensitivity C-reactive protein （CRP）, ANCA titer, and the Birmingham vasculitis activity score （BVAS）. Logistic regression analysis, Cox regression analysis and ROC curve were used to evaluate the risk factors of patients with renal involvement and all-event survival. Results Totally 64 patients were enrolled [ 24 females with the average age of （59.9±2.0） years and followed up for a median of （38±16） months. The morality rate was 14%, and the prevalence of end stage renal diSease was 39%. Compared with those who had better outcomes, patients who died or with end stage renal disease had higher serum creatinine level [ （624±246）, （245± 127） μmol/L, respectively, t=7.17, P=0.005] and erythrocyte sediment rate [（112±24）, （76±48） mm/l h, respectively, t= 3.74, P〈0.01], but lower serum albumin level [（294±31）, （316±42）g/L, respectively, t= -2.27, P=0.01 ] and hemoglobin leveI [ （79±13）, （99±33） g/L, respectively, t=-3.23, P〈0.01 ] at baseiine. Logistic regression analysis found that serum creatinine level and erythrocyte sediment rate at baseline were associated with poor outcome and Cox regression analysis further confirmed this result [Scr/3=1.004, 95%CI1.002~1.006, P〈0.01; ESR fl=l.018, 95%CI 1.000-1.037, P=0.046]. ROC curve analysis showed that serum creatinine and erythrocyte sediment rate were predictors for AAV patients＇ prognosis and their AUC were 0.95 and 0.80, the sensitivity of these parameters was both 94%, and the specificity was 93% and 70% respectively. Conclusion The intensity of initial treatment should be based on disease severity and activity in order to improve the prognosis of those with ANCA-associated vasculitis with renal involvement. Increased serum creatinine and erythrocyte sediment rate may serve as predictors for poor prognosis in this patient cohort.