抗中性粒细胞胞质抗体相关性血管炎并发感染的临床特点及危险因素

Clinical characteristics and risk factors of antineutrophil cytoplasmic antibody⁃associated vasculitis complicated with infection

目的分析抗中性粒细胞胞质抗体(antineutrophil cytoplasmic antibody,ANCA)相关性血管炎(ANCA-associated vasculitis,AAV)初诊患者的临床特点及发生感染的危险因素。方法回顾性收集2012年9月至2020年9月在青岛大学附属医院初诊AAV患者(随访至少6个月)的临床资料。根据随访过程中是否发生感染,分为感染组和非感染组,分析两组患者的临床特点及感染情况,并进一步采用Cox回归模型分析发生感染的影响因素。结果共236例AAV患者被纳入本研究,女性128例(54.2%),男性108例(45.8%),中位年龄为66.00(59.76,71.99)岁。髓过氧化物酶(myeloperoxidase,MPO)-ANCA阳性者202例(85.6%),蛋白酶3(proteinase 3,PR3)-ANCA阳性者34例(14.4%)。其中感染组77例,非感染组159例。77例感染组患者共发生121次感染,54次感染(44.6%)发生在初诊后6个月内。感染组合并高血压病史、肺部基础疾病及接受激素冲击治疗和血浆置换的患者比例,肺部、肾脏、心脏、胃肠道受累率,及初诊时血肌酐、五因子评分(five factors score,FFS)显著高于非感染组,而估算肾小球滤过率(estimated glomerular filtration rate,eGFR)显著低于非感染组,差异均有统计学意义(均P<0.05)。肺部(73.6%)是AAV患者的主要感染部位,最常见的病原微生物是细菌(64.0%),以铜绿假单胞菌、金黄色葡萄球菌为主;其次是真菌(33.7%,以白念珠菌为主)。多因素Cox回归分析显示肺部受累(HR=1.682,95%CI 1.034~2.734,P=0.036)、胃肠道受累(HR=2.976,95%CI 1.219~7.267,P=0.017)是AAV患者发生感染的独立影响因素。结论AAV患者在初诊后6个月内感染的发生率较高。AAV患者最常见的感染部位是肺部,常见的病原微生物是铜绿假单胞菌、金黄色葡萄球菌、白念珠菌。肺部受累、胃肠道受累是AAV患者发生感染的独立危险因素。

Objective To investigate the characteristics and risk factors of infection in newly diagnosed patients with antineutrophil cytoplasmic antibody(ANCA)⁃associated vasculitis(AAV).Methods The clinical data of AAV patients(followed up for at least 6 months)in Affiliated Hospital of Qingdao University from September 2012 to September 2020 were retrospectively collected.According to whether infection occurred during follow⁃up,the patients were divided into infection group and non⁃infection group.The clinical characteristics and infection status of the two groups were analyzed,and the Cox regression analysis model was used to explore the influencing factors of infection.Results A total of 236 AAV patients were enrolled in this study,including 128 females(54.2%)and 108 males(45.8%),with a median age of 66.00(59.76,71.99)years.There were 202 patients(85.6%)with positive myeloperoxidase(MPO)⁃ANCA and 34 patients(14.4%)with positive protease 3(PR3)⁃ANCA.There were 77 cases in the infection group and 159 cases in the non⁃infection group.A total of 121 infections occurred in 77 patients,and 54 infections(44.6%)occurred within 6 months after initial diagnosis.In the infection group the proportion of patients with hypertension history,pulmonary underlying diseases and patients who received hormone pulse therapy or plasma exchange,the incidence of lung,kidney,heart and gastrointestinal involvement,the level of serum creatinine and five factors score(FFS)at initial diagnosis were significantly higher than those in the non⁃infection group(all P<0.05),while the estimated glomerular filtration rate(eGFR)was significantly lower(P<0.05).Lung(73.6%)was the main infection organ of AAV patients.The most common pathogenic microorganisms were bacteria(64.0%),mainly Pseudomonas aeruginosa and Staphylococcus aureus,followed by fungi(33.7%,mainly Candida albicans).Multivariate Cox regression analysis showed that lung involvement(HR=1.682,95%CI 1.034-2.734,P=0.036)and gastrointestinal involvement(HR=2.976,95%CI 1.219-7.267,P=0.017)were the independent influencing factors for infection in AAV patients.Conclusions AAV patients have a higher incidence of infection within 6 months after initial diagnosis.The most common organ of infection in AAV patients is the lung,and the common pathogens are Pseudomonas aeruginosa,Staphylococcus aureus and Candida albicans.Lung involvement and gastrointestinal involvement are the independent risk factors for infection in AAV patients.