Patient-Reported Sinonasal Symptoms and Risk of Relapse in Antineutrophil Cytoplasmic Antibody-Associated Vasculitis.
Patient-Reported Sinonasal Symptoms and Risk of Relapse in Antineutrophil Cytoplasmic Antibody-Associated Vasculitis.
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患者报告的抗中性粒细胞胞质抗体相关性血管炎的鼻腔症状和复发风险。
DOI：
10.1002/acr.25329
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发表时间：
2024
影响因子：
4.7
通讯作者：
Rhee,RennieL
中科院分区：
文献类型：
--
作者：
Romich,Ellen;Banerjee,Shubhasree;Amudala,Naomi;Chou,Sherry;Li,Ruolan;Lee,Hongzhe;Cohen,Noam;Merkel,PeterA;Rhee,RennieL
目的抗中性粒细胞胞浆抗体相关性血管炎（AAV）复发频繁且难以预测，导致长期使用免疫抑制。尽管鼻窦疾病与 AAV 复发相关，但缺乏鼻窦症状的详细特征。使用患者报告的结果，即 22 项鼻腔结果测试 (SNOT-22)，我们研究了 AAV 鼻窦症状与疾病活动性之间的关系。方法这是一项针对 AAV 患者和健康个体的前瞻性纵向研究。复发定义为伯明翰血管炎活动评分中韦格纳肉芽肿评分>0。 SNOT-22 分数越高表明症状越严重。广义估计方程和 Cox 比例风险模型评估了 SNOT-22 与复发之间的关联。结果 168 名 AAV 患者和 51 名对照者共进行了 773 次就诊（106 次活动性疾病就诊）。与对照组相比，AAV 缓解期的中位 SNOT-22 较高（20 vs 5；P < 0.001），而活动性疾病期间的 SNOT-22 中位数则高于缓解期的中位值（P < 0.001）。在所有 AAV 中，特别是在肉芽肿性多血管炎中，在复发前数月至数年观察到较高的 SNOT-22 评分，并且与复发风险增加相关（风险比 2.7，95% 置信区间 1.2-6.2；P= 0.02）。在检查患有鼻腔疾病的患者与未患有鼻腔疾病的患者以及去除仅限于耳、鼻和喉咙的复发后，也发现了类似的结果。结论患者报告的鼻腔疾病结果测量指标 SNOT-22 不仅随 AAV 疾病活动度的变化而变化，而且与两年内较高的复发风险相关。这些发现支持了这样一种可能性：SNOT-22 评分可能会增强对复发的预测，并且持续性鼻腔疾病可能在复发的病理生理学中发挥重要作用。
ObjectiveRelapses are frequent and difficult to predict in antineutrophil cytoplasmic antibody–associated vasculitis (AAV), resulting in long‐term use of immunosuppression. Although sinonasal disease is associated with relapse of AAV, detailed characterization of sinonasal symptoms is lacking. Using a patient‐reported outcome, the 22‐item SinoNasal Outcome Test (SNOT‐22), we investigated the relationship between sinonasal symptoms and disease activity in AAV.MethodsThis was a prospective, longitudinal study of individual with AAV and healthy individuals. Relapse was defined as a Birmingham Vasculitis Activity Score for Wegner's Granulomatosis score >0. Higher SNOT‐22 scores indicate worse symptoms. Generalized estimating equation and Cox proportional hazard models evaluated the association between SNOT‐22 and relapse.ResultsThere were 773 visits (106 active disease visits) from 168 patients with AAV and 51 controls. Median SNOT‐22 at remission was higher in AAV versus controls (20 vs 5;P< 0.001) and higher during active disease versus remission (P< 0.001). In all AAV, and particularly within granulomatosis with polyangiitis, higher SNOT‐22 scores were observed months to years before relapse and were associated with increased risk of relapse (hazard ratio 2.7, 95% confidence interval 1.2–6.2;P= 0.02). Similar findings were seen when examining patients with versus without sinonasal disease and after removing relapses limited to the ear, nose, and throat.ConclusionA patient‐reported outcome measure of sinonasal disease, the SNOT‐22, not only changes with disease activity in AAV, but also is associated with a higher risk of relapse within two years. These findings support the possibility that the SNOT‐22 score may enhance prediction of relapse and that persistent sinonasal disease may be important in the pathophysiology of relapse.