抗中性粒细胞胞质抗体相关性血管炎的临床特征和疾病活动标志物的研究
Clinical characteristics and potential biomarkers for disease activity of patients with ANCA-associated vasculitis
刘云 1孔秀芳 1马莉莉 1纪宗斐 1陈荣毅 1陈慧勇 1姜林娣1
作者信息
- 1. 复旦大学附属中山医院风湿免疫科,上海 200032
- 折叠
摘要
目的 描述单中心抗中性粒细胞胞质抗体(ANCA)相关性血管炎(AAV)患者的临床特征,并评估血清学指标与疾病活动性的关系,寻求可用于评估疾病活动性的生物学标志物.方法 选取复旦大学附属中山医院2009年1月1日至2020年12月31日确诊的256例AAV患者为研究对象,回顾性分析其临床特点.采用SPSS 25.0软件对数据进行分析处理,采用t检验比较活动组和非活动组实验室指标的差异,并采用多因素lo-gistic回归分析探讨与AAV疾病活动度有关的生物学标志物,采用受试者工作特征(ROC)曲线分析不同指标的诊断效能.结果 256例AAV患者中显微镜下多血管炎(MPA)193例,肉芽肿性多血管炎(GPA)48例,嗜酸性肉芽肿性多血管炎(EGPA)15例.患者诊断时平均年龄(58.0±15.7)岁,其中MPA患者比GPA和EGPA大10岁左右(F=10.57,P＜0.001).MPA和EGPA以靶向髓过氧化物酶(MPO)-ANCA为主(分别为88.6％和40.0％),而GPA以靶向蛋白酶3(PR3)-ANCA(83.3％)为主.对所有患者而言,肺和肾脏最常受累(分别为68.4％和60.9％),GPA中五官受累(60.4％)常见,而EGPA患者皮肤(60.0％)和神经系统(46.7％)受累常见.多因素回归分析结果显示:MPO-ANCA＞66.15 U/ml[OR值(95％CI)=2.757(1.023,5.962),P=0.001]、ESR＞69.5 mm/1 h[OR值(95％CI)=3.962(1.014,9.461),P=0.002]、补体C4＞0.283 g/L[OR值(95％CI)=9.252(3.366,15.791),P＜0.001]是疾病活动的独立危险因素.诊断试验表明C4在灵敏度、阴性预测值、ROC曲线下面积(AUC)方面的诊断效能最高(分别为82.4％、58.3％、0.854),联合试验分析提示C4可以显著提高ESR和MPO-ANCA的灵敏度或特异度.结论 C4可以作为评估AAV疾病活动度的潜在生物学标志物.
Abstract
Objective To describe the clinical and serological features of patients with antineutrophil cytoplasmic antibody(ANCA)-associated vasculitis(AAV)in eastern China based on data from a hospital-based study.Indicators that can predict disease activity are explored.Methods Two hundred and fifty-six AAV patients diagnosed during January 1,2009 to December 31,2020 in Zhongshan Hospital,Fudan University were enrolled.The clinical features were retrospectively analyzed,SPSS 25.0 was used to analyze the data,t-test was applied to compare the differences between the laboratory indicators of the active group and the inactive group.Multivariate logistic regression analysis was used to explore the biological markers related to the disease activity of AAV.Receiver operating characteristic curve(ROC)was used to analyze the diagnostic efficacy of different indicators.Results Among 256 AAV patients,193 were MPA,48 were GPA and 15 were EGPA.The mean age at diagnosis of patients was(58.0±15.7)years,with MPA patients were about 10 years older than patients with GPA and EGPA.MPA and EGPA were positive for MPO-ANCA(88.6％and 40.0％,respectively),while GPA was mainly positive PR3-ANCA(83.3％).For all patients,the lungs and kidneys were the most commonly affected(68.4％and 60.9％,respectively),the era-nose-throat(ENT)were commonly affected(60.4％)in GPA,while skin(60.0％)and nervous system(46.7％)were commonly being affected in EGPA patients.The results of multivariate regression analysis showed that MPO-ANCA＞66.15 U/ml[OR(95％CI)=2.757(1.023,9.461),P=0.001],ESR＞69.5 mm/1 h[OR(95％CI)=3.962(1.014,9.461),P=0.002],and C4＞0.283 g/L[OR(95％CI)=9.252(3.366,15.791),P＜0.001]were independent risk factors for active disease.Diagnostic tests showed that C4 had the highest diagnostic efficacy in terms of sensitivity(82.4％),negative predictive value(58.3％)and area under the receiver operating characteristic(AUC=0.854).Combined test analysis suggested that C4 could significantly improve the sensitivity or specificity of ESR and MPO-ANCA.Conclusion C4 can serve as a potential biological marker for evaluating the disease activity of AAV patients.
关键词
抗中性粒细胞胞浆抗体相关性血管炎/活动性/标志物/补体4Key words
Anti-neutrophil cytoplasmic antibody-associated vasculitis/Disease activity/Biomarker/Comple-ment 4引用本文复制引用
基金项目
国家自然科学基金面上项目(82271834)
上海市科委科技创新行动计划面上项目(21Y11909100)
出版年
2024
NETL
NSTL
万方数据