Risk factors associated with relapse or infectious complications in Japanese patients with microscopic polyangiitis
Risk factors associated with relapse or infectious complications in Japanese patients with microscopic polyangiitis
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DOI：
10.1007/s10157-015-1199-7
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发表时间：
2016-10-01
影响因子：
2.3
通讯作者：
Wada, Takashi
中科院分区：
文献类型：
--
作者：
Kitagawa, Kiyoki;Furuichi, Kengo;Wada, Takashi
缓解维持治疗期间预防复发和感染并发症是改善表现为快速进展性肾小球肾炎（RPGN）的显微多血管炎（MPA）患者预后的必要条件。检查anca阳性MPA患者的临床病理特征，以确定缓解诱导治疗后复发或感染性并发症的危险因素。在日本RPGN指南发表后，研究人群包括2002年至2012年诊断为anca阳性MPA并显示RPGN的52例患者。临床病理结果检查有无复发或感染性并发症。复发组血管炎损伤指数（VDI）值较高，认为VDI值是复发的主导因素[危险比（HR） 3.36, 95%可信区间（CI） 1.58 ~ 7.12, P < 0.01]。另一方面，感染组的伯明翰血管炎活动度评分、诊断时RPGN的临床分级分类、缓解时VDI值均较高。RPGN的临床分级是感染并发症的主要影响因素（HR 5.30, 95% CI 1.41 ~ 19.9, P = 0.01）。诊断时的疾病活动性和缓解时器官损害的严重程度与缓解维持治疗期间的复发和感染并发症相关，感染并发症影响表现为RPGN的anca阳性MPA患者的肾脏生存和全因死亡率。
The prevention of relapse and infection complications during remission maintenance therapy is required to improve the prognosis of patients with microscopic polyangiitis (MPA) showing rapidly progressive glomerulonephritis (RPGN). The clinicopathological characteristics of patients with ANCA-positive MPA were examined to determine the risk factors for relapse or infectious complications after remission induction therapy.The study population consisted of 52 patients diagnosed as ANCA-positive MPA showing RPGN from 2002 to 2012, after publication of the Japanese guideline for RPGN. The clinicopathological findings were examined between the presence and absence of relapse or infectious complications.The value of vasculitis damage index (VDI) was high for the relapse group and VDI value was identified as the leading factor associated with relapse [hazard ratio (HR) 3.36, 95 % confidence interval (CI) 1.58-7.12, P < 0.01]. On the other hand, the values of Birmingham Vasculitis Activity Score, clinical grade category of RPGN at diagnosis, and VDI at remission were high in the infectious group. Furthermore, clinical grade category of RPGN was the leading factor associated with infectious complications (HR 5.30, 95 % CI 1.41-19.9, P = 0.01).The disease activity at diagnosis and severity of organ damage at remission were associated with relapse and infectious complications during remission maintenance therapy and infectious complication affected kidney survival and all-cause mortality in patients with ANCA-positive MPA exhibiting RPGN.