Environmental risk factors for ANCA glomerulonephritis

小血管炎导致严重的器官损害，最常累及肾脏和肺部。ANCA肾小球肾炎（ANCA- gn）是一种累及肾脏的小血管炎，累及或不累及肺或其他器官。ANCA GN是一种严重的疾病，其短期（< 3）死亡率为5-10%，其临床病程通常包括缓解期和复发期，并经常进展为慢性透析。在三个病例对照研究中，暴露于二氧化硅粉尘与ANA - GN风险增加4倍有关。这些研究的不足之处包括样本量小和暴露评估技术有限。吸烟也可能在血管炎的发生和发展中起作用，特别是在上呼吸道、肺部和肾脏，但从未作为一种危险因素进行过检查。本研究的目的是评估环境暴露，特别是二氧化硅和吸烟，在ANCA-GN的发生和发展中的作用。拟议的研究是基于人群的病例对照研究，使用详细的电话访谈来评估二氧化硅和吸烟暴露的强度和持续时间。该研究将包括200名被诊断为ANCA GN的患者和400名对照组。ANCA GN病例将通过肾活检诊断和ANCA阳性评估，通过北卡罗莱纳州、南卡罗来纳州和弗吉尼亚州南部的肾脏病理学服务来确定。病例将与他们的肾病专家联系，并将进行前瞻性随访，以评估二氧化硅和吸烟对临床结果的作用。年龄在18岁到64岁之间的控制者将通过随机数字电话拨号进行识别，65岁以上的控制者将通过卫生保健融资管理局的数据库记录进行识别。对照将根据性别和年龄组进行频率匹配。接触二氧化硅粉尘将由经验丰富的工业卫生师进行评估。考虑到本研究的样本量，统计能力为0.80，双侧alpha-0.05，相对常见的暴露的最小可检测比值比为1.7和1.8，高二氧化硅暴露为3.4，中等二氧化硅暴露为2.6。综上所述，本研究将扩大对二氧化硅粉尘和吸烟在ANCA-GN中的作用的认识。这是一种侵袭性疾病，其病因知之甚少。暴露于二氧化硅粉尘和吸烟是可改变的暴露，因此了解它们在ANCA-GN中的作用可能导致干预措施，以改善患者的预后。

Small vessel vasculitis results in significant organ damage, most often involving the kidney and lungs. ANCA glomerulonephritis (ANCA-GN) is a form of small vessel vasculitis with renal involvement, with or without involvement of the lungs of other organs. ANCA GN is a serious with a short-term (< 3 mortality of 5-10% and a clinical course that often includes periods of remission and relapse that frequently progresses to chronic dialysis. Exposure to silica dust has been associated with a 4-fold increase in risk of ANA GN in three case-control studies. Deficiencies in these studies include small sample size and limited exposure assessment techniques. Smoking may also play a role in the involvement and progression of vasculitis, especially in the upper airways, lungs and kidney, but has never been examined as a risk factor. The purpose of this study is to evaluate the role of environmental exposures, specifically silica and smoking, in the development and progression of ANCA-GN. The proposed study is population-based case control study using a detailed telephone interview to evaluate the intensity and duration of silica and smoking exposures. The study will include 200 patients diagnosed with ANCA GN and 400 controls. ANCA GN cases will be identified through Nephropathology services in NC, SC and Southern Virginia by renal biopsy diagnosis and positive ANCA evaluation. Cases will be contacted with their nephrologist and will be followed prospectively to evaluate the role of silica and smoking on clinical outcomes. Controls will be identified by random digit telephone dialing for those age 18 to 64, and by Health Care Financing Administration database records for those age 65. Controls will be frequency matched on gender, and age group. Exposure to silica dust will be assessed by and experienced Industrial Hygienist. Given the sample size in this study statistical power of 0.80 and a two-sided alpha-0.05, the minimum detectable odds ratio is 1.7 and 1.8 for the relatively common exposures will be 3.4 for high silica exposure and 2.6 for moderate silica exposure. In summary, this study will expand the knowledge of the role of silica dust and smoking in ANCA-GN. This is an aggressive disease for which little is known about etiology. Exposure to silica dust and smoking are modifiable exposures, therefore understanding their role in ANCA-GN may lead to interventions to improve patient outcomes.