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
吴锶凯 1徐文杰 1王健 2黄美春 2杨光钊 2敖炜群 2魏福全 2茅国群2
作者信息
- 1. 浙江中医药大学第二临床学院,浙江 杭州 310053
- 2. 浙江省立同德医院,浙江 杭州 310012
- 折叠
摘要
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,χ2=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.
Abstract
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 clini-cal 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 pro-portional hazard regression model was used to explore the risk factors of death.Results:Among the 51 patients,there were 15 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,χ2=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.
关键词
抗中性粒细胞胞浆抗体相关性血管炎/体层摄影术,X线计算机Key words
Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/Tomography,X-Ray Computed引用本文复制引用
基金项目
浙江省自然科学基金(LY17H290003)
出版年
2024
国家科技期刊平台
NSTL
维普
万方数据