抗中性粒细胞胞浆抗体相关性小血管炎合并血栓栓塞的危险因素分析

Analysis of risk factors of thromboembolism in patients with ANCA-associated vasculitis

目的分析抗中性粒细胞胞浆抗体相关性小血管炎(AAV)合并血栓栓塞事件的临床特征以及相关危险因素。方法对我院2013年1月至2018年12月期间确诊为AAV患者177例,其中28例合并动静脉血栓栓塞,149例未合并动静脉血栓栓塞。采用多因素logistic回归分析AAV合并血栓栓塞的高危因素。结果栓塞组发生在AAV活动期23例(82.1%),发生在缓解期5例(17.9%),50.0%发生在疾病诊断后2个月。栓塞组合并急性感染率、BVAS评分、血清肌酐、ESR水平高于未栓塞组,但血小板计数、C3水平低于未栓塞组(P<0.05)。多因素回归分析显示,合并急性感染、ESR、C3水平是AAV合并血栓栓塞的独立危险因素。结论AAV患者活动期,尤其在疾病诊断后的2个月,发生血栓栓塞的风险较高。合并急性感染、ESR升高、C3降低的AAV患者可能更易合并血栓栓塞。

Objective To analyze the clinical features and related risk factors of anti-neutrophil cytoplasmic antibody associated vasculitis(AAV)complicated with thromboembolism events.Methods A total of 177 patients diagnosed as AAV from January 2013 to December 2018 were collected,of which 28 patientswith ATE and VTE and 149 patients.Logistic regression analysis was used to explore the risk factors of AAV patients complicated with thromboembolism.Results In the embolization group,23 patients(82.1%)were in AAV active stage,five patients(17.9%)were in remission stage,and 50.0%of the patients suffered from the disease two months after the diagnosis.Compared with non-embolization group,the acute infection rate,BVAS score,serum creatinin and ESR level in embolization group were higher.However,the blood platelet count and C3 level were lower(P<0.05).Multivariate logistic regression analysis showed that complicated acute infection,the level of ESR and C3 were independent risk factors for AAV complicated with thromboembolism.Conclusion Patients with AAV have a higher risk of thromboembolism during the active period,especially two months after the diagnosis of the disease.AAV patients with acute infection,increased ESR and decreased C3 may be more susceptible to thromboembolism.