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。ANCA肾小球肾炎(ANCA-GN)是一种肾受累的小血管肾炎，可累及或不累及其他器官的肺部。Anca GN是一种严重的慢性肾炎，短期死亡率为5-10%，临床病程通常包括缓解期和复发期，经常进展为慢性透析。在三项病例对照研究中，接触二氧化硅粉尘与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发挥作用，特别是在上呼吸道、肺和肾脏，但从未被视为危险因素。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。这项拟议的研究是以人群为基础的病例对照研究，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。这项研究将包括200名被诊断为ANCA GN的患者和400名对照。ANCA GN病例将通过北卡罗来纳州、南卡罗来纳州和南弗吉尼亚州的肾脏病理服务，通过肾活检诊断和ANCA阳性评估来确定。患者将与他们的肾科医生联系，并进行前瞻性跟踪，以评估二氧化硅和吸烟对临床结果的作用。控制将通过随机数字电话拨号对18岁的进行识别，并通过卫生保健融资管理局的数据库记录对65岁的人进行识别。对照将在性别和年龄组上进行频率匹配。接触二氧化硅粉尘将由经验丰富的工业卫生师进行评估。在本研究中，样本大小为0.80，双面α-0.05，对于相对常见的暴露，最小可检测的赔率比为1.7，相对常见的暴露将为3.4，对于中等二氧化硅暴露，将为2.6。总之，这项研究将扩大对二氧化硅粉尘和吸烟在ANCA-GN中作用的认识。这是一种侵袭性疾病，对其病因知之甚少。接触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中的作用可能会导致干预措施来改善患者的预后。

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.