肺脏受累的抗中性粒细胞胞浆抗体相关性血管炎患者90例临床特征及预后影响因素分析

Analysis of clinical characteristics and prognostic factors in 90 patients of anti-neutrophil cytoplasmic antibody-associated vasculitis with pulmonary involvement

目的探讨肺脏受累的抗中性粒细胞胞浆抗体相关性血管炎(AAV)患者的临床特征及预后影响因素。方法将90例肺脏受累的AAV患者的临床资料进行回顾性分析,并随访至2019年9月30日,依据预后将患者分为存活组63例和死亡组27例,比较两组患者的临床资料,采用Kaplan-Meier法进行生存分析,建立Cox回归模型分析肺脏受累的AAV患者预后的因素。结果90例患者中男53例(58.9%),女37例(41.1%),平均年龄为(63.2±12.6)岁。肺脏受累以肺间质性病变多见(52例,57.8%),常合并肾脏损害(61例,67.8%)。死亡组患者发病年龄和诱导缓解期单用糖皮质激素患者比例均高于存活组,淋巴细胞计数、血清白蛋白水平及诱导缓解期使用糖皮质激素联合环磷酰胺患者比例均低于存活组(P<0.05)。Kaplan-Meier生存分析结果显示,年龄≥65岁、淋巴细胞计数<1.1×10^9/L、血清白蛋白<30 g/L、血肌酐≥500μmol/L患者的生存率较低,诱导缓解期接受糖皮质激素联合免疫抑制剂治疗患者的生存率较单用糖皮质激素患者高(P<0.05)。多因素Cox回归分析结果显示,发病时年龄≥65岁、血肌酐≥500μmol/L及诱导缓解期单用糖皮质激素为影响肺脏受累的AAV患者预后不良的独立危险因素(P<0.05)。结论AAV肺脏受累时以肺间质性病变多见,临床表现无特异性,发病时患者年龄≥65岁、血肌酐≥500μmol/L、诱导缓解期单用糖皮质激素为其预后不良的独立危险因素。

Objective To explore the clinical characteristics and prognostic factors in patients of anti-neutrophil cytoplasmic antibody-associated vasculitis(AAV)with pulmonary involvement.Methods Clinical data of 90 patients of AAV with pulmonary involvement all patients were retrospectively analyzed and followed up to September 30,2019.According to the prognosis,they were divided into survival group(63 cases)and death group(27 cases).Clinical data of two groups were compared.Kaplan-Meier method was conducted for survival analysis.Cox regression model was established to analyze factors affecting the prognosis of patients of AAV with pulmonary involvement.Results In 90 patients,53 cases(58.9%)were male and 37 cases(41.1%)were female,and their mean age was(63.2±12.6)years old.Interstitial lung disease(52 cases,57.8%)was common pulmonary manifestation,and often combined with kidney damage(61 cases,67.8%).The age of oneset and ratio of patients who received glucocorticoids alone for induction remission therapy in death group were significantly higher than those in survival group,while lymphocyte count,serum albumin level and ratios of patients who used glucocorticoid combined with cyclophosphamide during remission period were significantly lower than those in survival group(P<0.05).Kaplan-Meier survival analysis showed that survival rates were lower in patients with age≥65 years old,lymphocyte count<1.1×10^9/L,serum albumin<30 g/L and serum creatinine≥500μmol/L,survival rate of patients who received glucocorticoid combined with immunosuppressant for induction remission therapy was higher than that of patients who received glucocorticoid alone(P<0.05).Multivariate Cox regression analysis showed that age≥65 years old at onset,serum creatinine≥500μmol/L and glucocorticoids alone for induction remission therapy were independent risk factors of poor prognosis in patients of AAV with lung involvement.Conclusion Interstitial lung disease is the major lesion of AAV with pulmonary involvement and the clinical manifestations are not specific.Age≥65 years old at onset,serum creatinine≥500μmol/L and glucocorticoids alone for induction remission therapy are independent risk factors of poor prognosis.