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.

图/表 3

表1

表2

表3

参考文献 17

[1]	Jennette JC, Falk RJ, Bacon PA , et al. 2012 revised International Chapel Hill Consensus Conference Nomenclature of vasculitides[J]. Arthritis Rheum, 2013,65(1):1-11. doi: 10.1002/art.37715 pmid: 23045170
[2]	Yates M, Watts RA, Bajema IM , et al. EULAR/ERA-EDTA re-commendations for the management of ANCA-associated vasculitis[J]. Ann Rheum Dis, 2016,75(9):1583-1594.
[3]	Lanham JG, Elkon KB, Pusey CD , et al. Systemic vasculitis with asthma and eosinophilia: a clinical approach to the Churg-Strauss syndrome[J]. Medicine, 1984,63(2):65-81. doi: 10.1097/00005792-198403000-00001
[4]	Masi AT, Hunder GG, Lie JT , et al. The American College of Rheumatology 1990 criteria for the classification of Churg-Strauss syndrome (allergic granulomatosis and angiitis)[J]. Arthritis Rheum, 1990,33(8):1094-1100. doi: 10.1002/art.1780330806 pmid: 2202307
[5]	Leavitt RY, Fauci AS, Bloch DA , et al. The American College of Rheumatology 1990 criteria for the classification of Wegener’s granulomatosis[J]. Arthritis Rheum, 1990,33(8):1101-1107.
[6]	Watts R, Lane S, Hanslik T , et al. Development and validation of a consensus methodology for the classification of the ANCA-associated vasculitides and polyarteritis nodosa for epidemiolo-gical studies[J]. Ann Rheum Dis, 2007,66(2):222-227.
[7]	Luqmani RA, Bacon PA, Moots RJ , et al. Birmingham vasculitis activity score (BVAS) in systemic necrotizing vasculitis[J]. QJM, 1994,87(11):671.
[8]	Eisenberger U, Fakhouri F, Vanhille P , et al. ANCA-negative pauci-immune renal vasculitis: histology and outcome[J]. Nephrol Dial Transplant, 2005,20(7):1392-1399. doi: 10.1093/ndt/gfh830
[9]	Stone JH, Hoffman GS, Merkel PA , et al. A disease-specific activity index for Wegener’s granulomatosis: modification of the Birmingham vasculitis activity score[J]. Arthritis Rheum, 2001,44(4):912-920. doi: 10.1002/(ISSN)1529-0131
[10]	Exley AR, Bacon PA, Luqmani RA , et al. Development and initial validation of the vasculitis damage index for the standardized clinical assessment of damage in the systemic vasculitides[J]. Arthritis Rheum, 2014,40(2):371-380. doi: 10.1002/art.1780400222 pmid: 9041949
[11]	De GK, Gross WL, Herlyn K , et al. Development and validation of a disease extent index for Wegener’s granulomatosis[J]. Clin Nephrol, 2001,55(1):31-38. pmid: 11200865
[12]	Guillevin L, Lhote F, Gayraud M , et al. Prognostic factors in polyarteritis nodosa and Churg-Strauss syndrome. A prospective study in 342 patients[J]. Medicine, 1996,75(1):17-28. doi: 10.1097/00005792-199601000-00003
[13]	Guillevin L, Pagnoux C, Seror R , et al. The five-factor score revisited: assessment of prognoses of systemic necrotizing vasculitides based on the French Vasculitis Study Group (FVSG) cohort[J]. 2011,90(1):19-27. doi: 10.1097/MD.0b013e318205a4c6 pmid: 21200183
[14]	Moiseev S, Novikov P, Jayne D , et al. End-stage renal disease in ANCA-associated vasculitis[J]. Nephrol Dial Transplant, 2017,32(2):248-253. doi: 10.1093/ndt/gfw046 pmid: 27190338
[15]	Greenan K, Vassallo D, Chinnadurai R , et al. Respiratory manifestations of ANCA-associated vasculitis[J]. Clin Respir J, 2018,12(1):57-61. doi: 10.1111/crj.12478 pmid: 27059787
[16]	Frausova D, Hruskova Z, Lanska V , et al. Long-term outcome of patients with ANCA-associated vasculitis treated with plasma exchange: a retrospective, single-centre study[J]. Arthritis Res Ther, 2016(18):168. doi: 10.1186/s13075-016-1055-5 pmid: 4944267
[17]	张清, 周惠琼, 郭娟 , 等. 抗中性粒细胞胞质抗体相关性血管炎死亡危险因素的探讨[J]. 中华医学杂志, 2017,97(43):3392-3395.

相关文章 15

[1]	王飞,朱翔,贺蓓,朱红,沈宁. 自发缓解的滤泡性细支气管炎伴非特异性间质性肺炎1例报道并文献复习[J]. 北京大学学报（医学版）, 2021, 53(6): 1196-1200.
[2]	高伟波,石茂静,张海燕,吴春波,朱继红. 显著高铁蛋白血症与噬血细胞性淋巴组织细胞增多症的相互关系[J]. 北京大学学报（医学版）, 2021, 53(5): 921-927.
[3]	张梅香,史文芝,刘建新,王春键,李燕,王蔚,江滨. MLL-AF6融合基因阳性急性髓系白血病的临床特征及预后[J]. 北京大学学报（医学版）, 2021, 53(5): 915-920.
[4]	蒋艳芳,王健,王永健,刘佳,裴殷,刘晓鹏,敖英芳,马勇. 前交叉韧带翻修重建术后中长期临床疗效及影响因素[J]. 北京大学学报（医学版）, 2021, 53(5): 857-863.
[5]	肖若陶,刘承,徐楚潇,何为,马潞林. 术前血小板参数与局部进展期肾细胞癌预后[J]. 北京大学学报（医学版）, 2021, 53(4): 647-652.
[6]	于妍斐,何世明,吴宇财,熊盛炜,沈棋,李妍妍,杨风,何群,李学松. 延胡索酸水合酶缺陷型肾细胞癌的临床病理特征及预后[J]. 北京大学学报（医学版）, 2021, 53(4): 640-646.
[7]	赵勋,颜野,黄晓娟,董靖晗,刘茁,张洪宪,刘承,马潞林. 癌栓粘连血管壁对非转移性肾细胞癌合并下腔静脉癌栓患者手术及预后的影响[J]. 北京大学学报（医学版）, 2021, 53(4): 665-670.
[8]	陈怀安,刘硕,李秀君,王哲,张潮,李凤岐,苗文隆. 炎症生物标志物对输尿管尿路上皮癌患者预后预测的临床价值[J]. 北京大学学报（医学版）, 2021, 53(2): 302-307.
[9]	刘世博,高辉,冯元春,李静,张彤,万利,刘燕鹰,李胜光,罗成华,张学武. 腹膜后纤维化致肾盂积水的临床分析:附17例报道[J]. 北京大学学报（医学版）, 2020, 52(6): 1069-1074.
[10]	陈伟钱,戴小娜,余叶,王沁,梁钧昱,柯旖旎,易彩虹,林进. 原发性干燥综合征合并自身免疫性肝病的临床特点及预后分析[J]. 北京大学学报（医学版）, 2020, 52(5): 886-891.
[11]	姜妮,乔国梁,王小利,周心娜,周蕾,宋雨光,赵艳杰,任军. 中性粒细胞与淋巴细胞比例对评估接受过继性细胞免疫治疗的晚期胰腺癌患者预后的临床意义[J]. 北京大学学报（医学版）, 2020, 52(3): 597-602.
[12]	马茹,李鑫宝,闫风彩,林育林,李雁. 肿瘤间质比评估阑尾来源腹膜假黏液瘤的临床价值[J]. 北京大学学报（医学版）, 2020, 52(2): 240-246.
[13]	王文鹏,王捷夫,胡均,王俊锋,刘嘉,孔大陆,李健. 结直肠间质瘤临床病理特征及预后分析[J]. 北京大学学报（医学版）, 2020, 52(2): 353-361.
[14]	王骁,李兆星,范焕芳,魏莉瑛,郭旭瑾,郭娜,王彤. 罕见小肠囊腺瘤1例报道[J]. 北京大学学报（医学版）, 2020, 52(2): 382-384.
[15]	欧阳雨晴,倪莲芳,刘新民. 恶性孤立性肺结节患者预后因素分析[J]. 北京大学学报（医学版）, 2020, 52(1): 158-162.

Metrics

Viewed

Full text

Abstract

Cited

Shared

Discussed

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