抗中性粒细胞胞质抗体相关性血管炎的病情评估方法及其相关性

doi:10.19723/j.issn.1671-167X.2018.06.014

摘要/Abstract

摘要：

目的: 探讨抗中性粒细胞胞质抗体相关性血管炎(anti-neutrophil cytoplasmic antibodies-associated vasculitis,AAV)病情评估方法的意义及其各自的相关性。方法: 以121例来自北京大学国际医院和中国人民解放军总医院第四医学中心住院确诊的AAV患者为研究对象,包括嗜酸性肉芽肿性多血管炎(eosinophilic granulomatous with polyangiitis,EGPA)15例、肉芽肿性多血管炎(granulomatous with polyangiitis,GPA)59例及显微镜下多血管炎(microscopic polyangiitis,MPA)47例。依据随访中是否死亡,将其分为死亡组和生存组,分别应用伯明翰系统性血管炎活动评分(Birmingham vasculitis activity score,BVAS)-1994、BVAS-2003、BVAS/GPA、血管炎损伤指数(vasculitis damage index,VDI)、疾病范围指数(disease extent index,DEI)、5因子评估量表(five factor score,FFS)-1996及FFS-2009共7种病情评价量表进行评分,比较两组间各指标的相关性。结果: 死亡组患者各项评估指标(BVAS、VDI、DEI及FFS)得分均明显高于生存组(P<0.05),且EGPA患者无论在疾病活动度(BVAS 1994/2003)、器官受累情况(VDI/DEI)还是疾病预测因子(FFS 1996/2009)评分方面均低于GPA、MPA和总AAV患者。其中BVAS-2003与BVAS-1994、BVAS/GPA之间具有高度相关性(r值分别为0.9和0.7),BVAS-1994与BVAS/GPA之间呈一般性相关(r=0.69);FFS-1996与FFS-2009之间具有高度相关性(r=0.73);DEI与BVAS-1994、BVAS-2003及BVAS/GPA之间均呈一般性相关(r值分别为0.62、0.65和0.62),VDI与BVAS-1994和BVAS-2003之间亦呈一般性相关(r值分别为0.49和0.52)。结论: AAV各评估指标均可作为评测疾病活动性及判断预后的指标,其中BVAS-2003与BVAS-1994及BVAS/GPA之间,FFS-1996与FFS-2009之间均呈高度相关性。

关键词: 抗中性粒细胞胞质抗体相关性血管炎, 预后, 疾病活动性

Abstract:

Objective: To investigate the significance of a set of seven disease activities and extension measurements and their correlations between one and another for anti-neutrophil cytoplasmic autoantibody associated vasculitis (AAV).Methods:A total of 121 patients from Peking University International Hospital and Fouth Medical Center of PLA General Hospital with confirmed diagnoses of AAV clinically were enrolled in the study, including 15 cases of eosinophilic granulomatous with polyangiitis (EGPA), 59 cases of granulomatous with polyangiitis (GPA) and 47 cases of microscopic polyangiitis (MPA). A hundred and twenty-one AAV patients were divided into death group and survival group according to their survival conditions. A set of seven disease assessment scales including Birmingham vasculitis activity score (BVAS)-1994, BVAS-2003, as well as BVAS/GPA, vasculitis damage index (VDI), disease extent index (DEI), five factor score (FFS)-1996, and FFS-2009 were measured and scored one by one, and their relationships which were represented by Spearman correlation coefficient were compared between one and another.Results:BVAS-1994, BVAS-2003, as well as BVAS/GPA, VDI, DEI, and FFS, all of those seven evaluation indexes of the AAV patients in the death group were significantly higher than those in the survival group (P<0.05). Except for BVAS/GPA, all those above indicators in the patients with EGPA were lower than those in the patients with GPA and those in the patients with MPA, and those in all of the AAV patients as a whole group. There were high correlations among BVAS-2003, BVAS-1994 and BVAS/GPA (r values were 0.9 and 0.7, respectively); BVAS-1994 was fairly correlated with BVAS/GPA (r=0.69); FFS-1996 and FFS-2009 were highly correlated (r=0.73) with each other; BVAS-1994, BVAS-2003 and BVAS/GPA were fairly correlated with DEI (with r values of 0.62, 0.65, and 0.62, respectively); VDI was also fairly correlated with BVAS-1994 and with BVAS-2003 (r values were 0.49 and 0.52, respectively).Conclusion:All of those seven AAV assessment indicators above can be used as indicators of disease activity and prognosis in AAV patients, most of which were relevant within one and another. There were high correlations among BVAS-2003, BVAS-1994 and BVAS/GPA, and besides, there were also high correlations between FFS-1996 and FFS-2009.

Key words: Anti-neutrophil cytoplasmic antibody-associated vasculitis, Prognosis, Disease activities

中图分类号:

R593.9

李胜光,张清,周惠琼. 抗中性粒细胞胞质抗体相关性血管炎的病情评估方法及其相关性[J]. 北京大学学报（医学版）, 2018, 50(6): 1022-1026.

Sheng-guang LI,Qing ZHANG,Hui-qiong ZHOU. Comparison of disease activities and extent measurements for anti-neutrophil cytoplasmic autoantibody-associated vasculitis[J]. Journal of Peking University(Health Sciences), 2018, 50(6): 1022-1026.

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Items	EGPA (n=15)	MPA (n=47)	GPA (n=59)	AAV (n=121)
BVAS-1994	16.2±8.4	23.5±6.0^*	23.3±9.4^*	22.5±8.4^*
BVAS-2003	16.9±7.7	22.4±6.8^*	22.8±9.8^*	21.9±8.6^*
VDI	3.1±2.5	4.2±2.5	4.0±2.4	4.0±2.5
DEI	8.2±3.1	7.8±2.8	8.9±3.2	8.4±3.0
FFS-1996	0.1±0.4	1.5±1.1^*	0.9±1.0^*	1.0±1.1^*#
FFS-2009	0.1±0.4	1.4±0.9^*	1.0±1.0^*#	1.1±1.0^*#

Items	Death group (n=25)	Survival group (n=96)	t	P
Age/years	69±11	60±16	2.8	0.006
BVAS-1994	26.2±7.5	21.0±8.5	2.8	0.006
BVAS-2003	26.9±8.3	20.0±8.8	3.5	0.001
BVAS/GPA	8.3±4.9	5.9±2.9	2.2	0.031
VDI	5.8±2.4	3.5±2.2	4.6	<0.001
DEI	9.5±3.5	8.0±2.8	2.2	0.028
FFS-1996	1.5±1.2	0.9±1.0	2.7	0.008
FFS-2009	1.8±1.1	0.9±0.9	4.0	<0.001

Items	BVAS-1994	BVAS-2003	BVAS/GPA	VDI	DEI	FFS-1996	FFS-2009
BVAS-1994	1
BVAS-2003	0.90^*	1
BVAS/GPA	0.69^*	0.70^*	1
VDI	0.49^*	0.52^*	0.37^*	1
DEI	0.62^*	0.65^*	0.62^*	0.37^*	1
FFS-1996	0.44^*	0.45^*	0.23	0.31^*	0.30^*	1
FFS-2009	0.38^*	0.39^*	0.09	0.28^*	0.23^#	0.73^*	1