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ANCA相关性血管炎的早期诊断至关重要

作者:Houben E,et al. 译者:北医三院姚中强 来源:中国风湿病公众论坛 日期:2018-01-19
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         【前沿进展】ANCA相关性血管炎的早期诊断至关重要

关键字:  ANCA相关性血管炎 

        摘要 背景:ANCA相关性血管炎急性期之前常有前驱期。本研究目的是分析肾损伤与前驱期长短的相关性。方法:来自一项单中心回顾性队列研究的ANCA相关性血管炎和肾损伤患者根据其前驱期长短分为两组。前驱期定义为第一个血管炎相关症状出现和诊断之间的时间。比较两组间诊断时和6月后的临床特点和血管炎损伤量表上的肾脏条目。而且还研究了长前驱期和3年终末期肾病和死亡率等结局的相关性。结果:共纳入72名患者 (年龄 64±12岁;74% 男性; 96% 白种人)。诊断时,前驱期≤22周和 >22周的患者的估计的肾小球滤过率和蛋白尿并无显著统计学差异(35 (四分位数间距50) vs 30 (50) ml/min, p=0.84; 75% vs 87%,p=0.21)。而且,伯明翰血管炎活动性积分两组是可比的(7(3), p=0.71)。6月后,多元分析显示长前驱期与蛋白尿相关(风险比 5.38, 95% 可信区间(CI) 1.47-19.62),但与估计的肾小球滤过率≤50ml/min无关 (风险比 0.89, 95% CI 0.33-2.37)。而且,长前驱期与终末期肾病/死亡率相关(危害比 5.22, 95% CI 1.13-24.20)。结论:长前驱期与蛋白尿和3年终末期肾病/死亡率相关,但与6月时肾功能下降无关。这些结果提示,为了改善肾脏预后,ANCA相关性血管炎的早期诊断至关重要。

        附原文:AbstractBACKGROUND:In ANCA-associatedvasculitisthe acute phase of the disease is oftenpreceded by prodromal symptoms. The aim of the present study was to analyze therelation between the duration of the prodromal phase and renal damage.METHODS:Patientswith ANCA-associatedvasculitisand renal involvement from aretrospective single-center cohort were divided into two equal groups based onthe duration of the prodromal phase. The prodromal phase was defined as thetime between firstvasculitisrelated symptoms and the date ofdiagnosis. Clinical characteristics at diagnosis and renal items on the vasculitis damage index at 6 months were compared between the two groups. In addition, the relation between a long prodromal phase and 3-yearend-stage renal disease and mortality as a composite outcome was studied.RESULTS:Atotal of 72 patients were included (age 64±12years; 74%male; 96% Caucasian). At diagnosis, in patients with a prodromal phase≤22weeks versus >22weeks estimated glomerular filtration rateand proteinuria did not differ significantly (35 (interquartile range 50)versus 30 (50) ml/min p=0.84; 75% versus87%, p=0.21respectively). Furthermore, BirminghamVasculitis Activity Scores werecomparable (7 (3), p=0.71). At 6months, a long prodromal phase was associated with proteinuria (odds ratio5.38, 95% confidence interval (CI) 1.47-19.62), but not with an estimatedglomerular filtration rate≤50ml/min(odds ratio 0.89, 95% CI 0.33-2.37) in multivariable analyses. In addition, along prodromal phase was associated with end-stage renal disease/mortality(hazard ratio 5.22, 95% CI 1.13-24.20). CONCLUSIONS: A long prodromal phase wasassociated with proteinuria and 3-year end-stage renal disease/mortality, butnot with a reduced renal function at 6 months. These results underline theimportance of an early diagnosis in ANCA associated vasculitis patients in order to improve renaloutcomes.

        引自:Houben E,Groenland SL,van der Heijden JW,Voskuyl AE,Doodeman HJ,Penne EL.Relationbetween duration of the prodromal phase and renal damage inANCA-associatedvasculitis.BMC Nephrol.2017;18(1):378

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