Predictors of treatment resistance and relapse in antineutrophil cytoplasmic antibody-associated small-vessel vasculitis: comparison of two independent cohorts.
Predictors of treatment resistance and relapse in antineutrophil cytoplasmic antibody-associated small-vessel vasculitis: comparison of two independent cohorts.
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DOI：
10.1002/art.23800
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发表时间：
2008-09
影响因子：
--
通讯作者：
Nachman, Patrick H.
中科院分区：
文献类型：
--
作者：
Pagnoux, Christian;Hogan, Susan L.;Chin, Hyunsook;Jennette, J. Charles;Falk, Ronald J.;Guillevin, Loic;Nachman, Patrick H.
美国东南部肾小球疾病协作网络（GDCN）已经确定了抗中性粒细胞细胞质抗体（ANCA）相关血管炎患者治疗耐药和复发的预测因素。这项研究是为了评估这些预测因子在法国血管炎研究小组随访的独立队列中的适用性。使用逻辑回归模型评估治疗耐药性的预测因子，并以95%置信区间（95% ci）的比值比（ORs）报告。使用Cox比例风险模型评估复发预测因子，并以95% ci的风险比（hr）报告。控制模型的年龄、性别、种族、基线血清肌酐水平和环磷酰胺治疗。法国队列（n = 434）和GDCN队列（n = 350）具有相似的中位随访期（44个月对45个月）和初始服用环磷酰胺的患者百分比（82%对78%）。法国队列包括更多的蛋白酶3 (PR3) ANCA患者（58%对40%），肺部受累（58%对49%）和上呼吸道受累（62%对31%）。在GDCN队列治疗耐药的预测因素中（女性、非裔美国人种族、骨髓过氧化物酶ANCA的存在、肌酐水平升高和年龄），只有年龄可以预测法国队列的治疗耐药（OR为1.32 / 10年[95% CI 1.05-1.66]）。GDCN队列中复发的预测因子为PR3 ANCA （HR 1.77 [95% CI 1.11-2.82]）、肺受累（HR 1.68 [95% CI 1.10-2.57]）和上呼吸道受累（HR 1.58 [95% CI 1.00-2.48]），而法国队列中的预测因子为PR3 ANCA （HR 1.66 [95% CI 1.15-2.39]）和肺受累（HR 1.56 [95% CI 1.11-2.20]），但不包括上呼吸道受累（HR 0.96 [95% CI 0.67-1.38]）。我们的研究结果表明，年龄较大是治疗耐药的预测因素，PR3 ANCA和肺部受累是两个队列中复发的预测因素。治疗道耐药预测指标的差异可能反映了治疗可及性的差异，而复发预测指标的差异可能反映了疾病表达的差异。
Predictors of treatment resistance and relapse have been identified in patients with antineutrophil cytoplasmic antibody (ANCA)–associated vasculitis in the Glomerular Disease Collaborative Network (GDCN) in the southeastern US. This study was undertaken to evaluate the applicability of those predictors in an independent cohort followed up by the French Vasculitis Study Group. Predictors of treatment resistance were evaluated using logistic regression models and reported as odds ratios (ORs) with 95% confidence intervals (95% CIs). Predictors of relapse were evaluated using Cox proportional hazards models and reported as hazard ratios (HRs) with 95% CIs. Models were controlled for age, sex, race, baseline serum creatinine level, and cyclophosphamide therapy. The French cohort (n = 434) and the GDCN cohort (n = 350) had similar median followup periods (44 months versus 45 months) and initial percentages of patients taking cyclophosphamide (82% versus 78%). The French cohort included more patients with proteinase 3 (PR3) ANCA (58% versus 40%), lung involvement (58% versus 49%), and upper respiratory tract involvement (62% versus 31%). Of the predictors of treatment resistance in the GDCN cohort (female sex, African American race, presence of myeloperoxidase ANCA, elevated creatinine level, and age), only age predicted treatment resistance in the French cohort (OR 1.32 per 10 years [95% CI 1.05–1.66]). Predictors of relapse in the GDCN cohort were PR3 ANCA (HR 1.77 [95% CI 1.11–2.82]), lung involvement (HR 1.68 [95% CI 1.10–2.57), and upper respiratory tract involvement (HR 1.58 [95% CI 1.00–2.48]), while predictors in the French cohort were PR3 ANCA (HR 1.66 [95% CI 1.15–2.39]) and lung involvement (HR 1.56 [95% CI 1.11–2.20]), but not upper respiratory tract involvement (HR 0.96 [95% CI 0.67–1.38]). Our findings indicate that older age is a predictor of treatment resistance, and that PR3 ANCA and lung involvement are predictors of relapse in both cohorts. Discrepancies in predictors of treatment tract resistance may reflect differences in access to care, and differences in predictors of relapse may reflect variations in disease expression.
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影响因子：
39.2
作者：
Hogan, SL;Falk, RJ;Nachman, PH
通讯作者：
Nachman, PH
影响因子：
4.6
作者：
Popa, ER;Stegeman, CA;Tervaert, JWC
通讯作者：
Tervaert, JWC
影响因子：
6.1
作者：
Haubitz, M;Koch, KM;Brunkhorst, R
通讯作者：
Brunkhorst, R
DOI：
10.1002/art.10922
发表时间：
2003-02-15
期刊：
ARTHRITIS & RHEUMATISM-ARTHRITIS CARE & RESEARCH
影响因子：
--
作者：
Guillevin, L;Cohen, P;Cordier, JF
通讯作者：
Cordier, JF
影响因子：
5.1
作者：
BRIEDIGKEIT, L;KETTRITZ, R;NATUSCH, R
通讯作者：
NATUSCH, R