CAJ | 학술논문

目的探讨肾脏受累为主的抗中性粒细胞胞质抗体(ANCA)相关性血管炎患者的预后及其影响因素.方法对2006-2008年我院诊断的64例肾脏受累为主的ANCA相关性血管炎患者进行回顾性分析,并对其进行前瞻性随访,使用Logistic回归、Cox回归等分析与患者肾脏预后有关的危险因素.结果 ①共入选64例患者,其中男性40例,女性24例,平均年龄(59.9±2.0)岁.随访21～55个月,平均(38±16)个月,期间34例(53％)患者出现死亡或进入长期肾脏替代治疗.②预后不同的2组患者起病时血肌酐[分别为(624±246)、(245±127) μmol/L,t=7.17,P=0.005]、红细胞沉降率(ESR)[分别为(112±24)、(76±48) mm/l h,t＝3.74,P＜0.01]、血浆白蛋白[分别为(294±31)、(316±42) g/L,t=-2.27,P=0.01]、血红蛋白[分别为(79±13)、(99±33) g/L,t=-3.23,P＜0.01 ]差异均有统计学意义.Logistic回归及Cox回归分析证实起病时血肌酐[β=1.004,95％可信区间(CI) 1.002～1.006,P＜0.01]及ESR[β=1.018,95％CI1.000～1.037,P=0.046]是预测患者预后的独立危险因素.③ROC曲线结果显示起病时血肌酐和ESR曲线下面积分别为0.95,0.80;敏感性均为94％,特异性分别为93％和70％.结论以肾脏受累为主的ANCA相关性血管炎患者预后差,起病时血肌酐水平和ESR可能是判断患者预后的重要影响因素.
목적 탐토신장수루위주적항중성립세포포질항체(ANCA)상관성혈관염환자적예후급기영향인소.방법 대2006-2008년아원진단적64례신장수루위주적ANCA상관성혈관염환자진행회고성분석,병대기진행전첨성수방,사용Logistic회귀、Cox회귀등분석여환자신장예후유관적위험인소.결과 ①공입선64례환자,기중남성40례,녀성24례,평균년령(59.9±2.0)세.수방21～55개월,평균(38±16)개월,기간34례(53％)환자출현사망혹진입장기신장체대치료.②예후불동적2조환자기병시혈기항[분별위(624±246)、(245±127) μmol/L,t=7.17,P=0.005]、홍세포침강솔(ESR)[분별위(112±24)、(76±48) mm/l h,t＝3.74,P＜0.01]、혈장백단백[분별위(294±31)、(316±42) g/L,t=-2.27,P=0.01]、혈홍단백[분별위(79±13)、(99±33) g/L,t=-3.23,P＜0.01 ]차이균유통계학의의.Logistic회귀급Cox회귀분석증실기병시혈기항[β=1.004,95％가신구간(CI) 1.002～1.006,P＜0.01]급ESR[β=1.018,95％CI1.000～1.037,P=0.046]시예측환자예후적독립위험인소.③ROC곡선결과현시기병시혈기항화ESR곡선하면적분별위0.95,0.80;민감성균위94％,특이성분별위93％화70％.결론 이신장수루위주적ANCA상관성혈관염환자예후차,기병시혈기항수평화ESR가능시판단환자예후적중요영향인소.
Objective To investigate the outcome and risk factors for kidney involvement by analyzing 64 patients with anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis.Methods Data analyzed including the demographic information,survival status,renal survival status and laboratory parameters such as serum albumin level,serum creatinine level,urinary protein excretion level,hematuria,high sensitivity C-reactive protein (CRP),ANCA titer,and the Birmingham vasculitis activity score (BVAS).Logistic regression analysis,Cox regression analysis and ROC curve were used to evaluate the risk factors of patients with renal involvement and all-event survival.Results Totally 64 patients were enrolled [24 females with the average age of (59.9±2.0) years] and followed up for a median of (38±16) months.The morality rate was 14％,and the prevalence of end stage renal disease was 39％.Compared with those who had better outcomes,patients who died or with end stage renal disease had higher serum creatinine level [ (624±246),(245±127 ) μ mol/L,respectively,t=7.17,P＝0.005 ] and erythrocyte sediment rate [ (112±24),(76±48) mm/1 h,respectively,t=3.74,P＜0.01 ],but lower serum albumin level [(294±31 ),(316±42) g/L,respectively,t=-2.27,P=0.01 ] and hemoglobin level [ (79±13),(99±33) g/L,respectively,t=-3.23,P＜0.01 ] at baseline.Logistic regression analysis found that serum creatinine level and erythrocyte sediment rate at baseline were associated with poor outcome and Cox regression analysis further confirmed this result [Scrβ=1.004,95％CI1.002～1.006,P＜0.01; ESR β=l.018,95％CI 1.000～1.037,P=0.046].ROC curve analysis showed that serum creatinine and erythrocyte sediment rate were predictors for AAV patients' prognosis and their AUC were 0.95 and 0.80,the sensitivity of these parameters was both 94％,and the specificity was 93％ and 70％respectively.Conclusion The intensity of initial treatment should be based on disease severity and activity in order to improve the prognosis of those with ANCA-associated vasculitis with renal involvement.Increased serum creatinine and erythrocyte sediment rate may serve as predictors for poor prognosis in this patient cohort.