ANCA相关性血管炎合并间质性肺病:临床表现、影像特征及预后分析

ANCA-associated vasculitis with interstitial lung disease:clinical manifestations,imaging features and prognostic analysis

目的:分析ANCA相关性血管炎(AAV)合并间质性肺病(ILD)患者的临床表现、影像学特征及预后,并探讨相关危险因素。方法:回顾性分析2012年7月—2022年6月就诊于浙江省立同德医院的51例AAV患者临床资料。根据HRCT表现分为AAV合并ILD(AAV-ILD)组15例与AAV未合并ILD(AAV-NILD)组36例,比较两组患者临床表现、实验室检查、肺功能、胸部CT表现及预后。采用多因素Logistic回归模型分析AAV合并ILD相关危险因素;运用Kaplan-Meier法进行生存分析;应用Cox比例风险回归模型探讨死亡危险因素。结果:两组相比,AAV-ILD组肺部受累症状明显,中位发病年龄高,有统计学意义(P<0.05)。AAV-ILD组患者生存率明显低于AAV-NILD组(Log rank,χ~2=4.331,P=0.037);年龄>65岁为AAV合并ILD的独立危险因素;通过单因素分析显示吸烟(HR=6.446,95%CI 1.380~30.113,P=0.018)及肺部蜂窝影(HR=6.302,95%CI 1.174~33.817,P=0.032)是AAV合并ILD患者生存期缩短的危险因素(P<0.05)。结论:AAV患者早期临床症状如以肺部受累为主时要警惕合并ILD可能,尤其是老年患者;吸烟及出现肺部蜂窝影是AAV合并ILD患者生存期缩短的危险因素。

Objective:To analyze the clinical manifestations,imaging features and the prognosis of patients with ANCA-associated vasculitis(AAV) combined with interstitial lung disease(ILD),and to explore related risk factors.Methods:The clinical data of 51 AAV patients who were treated at Tongde Hospital of Zhejiang Province from July 2012 to June 2022 were retrospectively analyzed.According to the HRCT findings,the patients were divided into AAV combined with ILD(AAV-ILD)group and AAV without ILD(AAV-NILD) group,and the clinical manifestations,laboratory examinations,lung function,chest CT findings,and prognosis were compared between the two groups.Multiple Logistic regression models were used to analyze the risk factors associated with AAV combined with ILD.Kaplan-Meier method was used for survival analysis,and Cox proportional hazard regression model was used to explore the risk factors of death.Results:Among the 51 patients,there were15 cases in the AAV-ILD group and 36 cases in the AAV-NILD group.Compared with the AAV-NILD group,the AAV-ILD group had more obvious pulmonary involvement symptoms and higher median onset age,with statistical significance(P<0.05).The survival rate of patients in the AAV-ILD group was significantly lower than that in the AAV-NILD group(Log rank,χ~2=4.331,P=0.037).Age>65 years was an independent risk factor for AAV combined with ILD.Univariate survival analysis showed that smoking(HR=6.446,95%CI 1.380~30.113,P=0.018) and lung honeycomb shadows(HR=6.302,95%CI 1.174~33.817,P=0.032)were risk factors for shortened survival of AAV combined with ILD.Conclusion:Early clinical symptoms of AAV patients,such as lung involvement,should be cautious of the possibility of concomitant ILD,especially in elderly patients.Smoking and appearance of lung honeycomb shadows are risk factors for shortened survival in AAV combined with ILD patients.