Immunoadsorption Improves Remission Rates of Patients with Antineutrophil Cytoplasmic Antibody-Associated Vasculitis and Severe Kidney Involvement
Immunoadsorption Improves Remission Rates of Patients with Antineutrophil Cytoplasmic Antibody-Associated Vasculitis and Severe Kidney Involvement
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免疫吸附可提高抗中性粒细胞胞质抗体相关性血管炎和严重肾脏受累患者的缓解率
DOI：
10.1159/000519608
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发表时间：
2022-01-01
影响因子：
4.2
通讯作者：
Zeng, Rui
中科院分区：
文献类型：
--
作者：
Chu, Xiaoxin;Hong, Yu;Zeng, Rui
简介：血浆置换在治疗抗神经细胞胞浆抗体（ANCA）相关性血管炎（AAV）伴严重肾脏受累中的作用存在争议。因此，寻找有效的治疗方法以改善AAV患者的预后是当务之急。在这项回顾性研究中，免疫吸附（IA）蛋白A的AAV患者严重肾脏受累的结果进行了评价。方法：分析60例AAV合并严重肾脏损害患者的临床资料。患者接受环磷酰胺或利妥昔单抗诱导缓解，其中16例额外接受IA治疗。比较缓解、终末期肾病（ESKD）、死亡和复发。结果：60例患者中，髓过氧化物酶（MPO）-ANCA阳性56例（93.3%）。诊断时，估计的肾小球滤过率和伯明翰血管炎活动性评分（BVAS）分别为13.0（7.7，18.7）mL/min/1.73 m2和11.1 ± 3.4。诱导治疗3-17天（平均10.4天）后，IA组的疾病活动度比对照组下降更明显（p = 0.022）。IA在治疗后3-31天（中位数11天）内的MPO-ANCA清除率上级标准方案（78.4% vs. 9.3%，p = 0.005）。在中位随访20.2个月后，IA组比对照组更快（p = 0.035）和更高（风险比（HR）= 2.3，95%置信区间（CI）：1.1 - 7.2，p = 0.033）达到缓解。IA治疗在降低死亡率方面具有优势（HR = 0.2，95% CI：0.1 - 0.9，p = 0.032）。两组发展为ESKD的情况无差异（HR = 0.7，95% CI：0.3 ~ 2.0，p = 0.504）。多变量考克斯回归分析表明，早期缓解是ESKD（HR = 0.03，95% CI：0.003 ~ 0.25，p = 0.001）和死亡（HR = 0.07，95% CI：0.01 ~ 0.51，p = 0.009）的独立预测因素。结论：IA治疗可使伴有严重肾损害的AAV患者获得更快、更高的缓解率和更低的死亡率。早期缓解独立预测这些患者的结局。
Introduction: The role of plasma exchange in treatment of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) with severe kidney involvement is controversial. It is urgent to find effective treatments to improve prognosis of AAV patients. In this retrospective study, the outcomes of immunoadsorption (IA) onto protein A in AAV patients with severe kidney involvement were evaluated. Methods: Clinical data of 60 patients with AAV and severe kidney involvement were analyzed. Patients received cyclophosphamide or rituximab for remission induction, among which 16 were additionally treated with IA. Remission, end-stage kidney disease (ESKD), death, and relapse were compared. Results: Of 60 patients, 56 patients (93.3%) were positive for myeloperoxidase (MPO)-ANCA. At diagnosis, the estimated glomerular filtration rate and Birmingham Vasculitis Activity Score (BVAS) was 13.0 (7.7, 18.7) mL/min/1.73 m2 and 11.1 ± 3.4, respectively. After 3–17 days (mean 10.4 days) of induction treatment, the disease activity decreased more obviously in the IA group (p = 0.022) than the control group. IA showed superior over standard regimen in clearance of MPO-ANCA within 3–31 days (median 11 days) after treatment (78.4% vs. 9.3%, p = 0.005). After a median follow-up of 20.2 months, remission was achieved more quickly (p = 0.035) and higher (hazard ratio (HR) = 2.3, 95% confidence interval (CI): 1.1∼7.2, p = 0.033) in the IA group than the control group. IA therapy showed an advantage in reducing death (HR = 0.2, 95% CI: 0.1∼0.9, p = 0.032). There was no difference in developing into ESKD in both groups (HR = 0.7, 95% CI: 0.3∼2.0, p = 0.504). Multivariate Cox regression analysis indicated that early-stage remission was an independent predictor for ESKD (HR = 0.03, 95% CI: 0.003∼0.25, p = 0.001) and death (HR = 0.07, 95% CI: 0.01∼0.51, p = 0.009). Conclusion: IA treatment induces quicker and higher remission and lower mortality in AAV patients with severe kidney involvement. The early remission independently predicts the outcomes for these patients.