近半数AAV患者发生严重感染且与高龄及肾功能受损相关

作者：Mohammad AJ. et al

  翻译：北医三院翟佳羽（[e-mail]）

摘要

目的：比较抗中性粒细胞胞浆抗体（ANCA）相关性血管炎（AAV）患者和背景人群严重感染的发生率，并明确AAV患者严重感染的预测因素。

方法：这项研究队列纳入从1998年到2010年诊断的186例AAV患者，包括瑞典南部特定人群中的所有已知病例。对于每位患者，从背景人群中挑选4例年龄及性别与之相匹配的对照者。采用Skane卫生保健登记系统，明确所有从1998年到2011年感染性疾病的国际分类编码。严重感染定义为需要住院治疗的感染。AAV感染发生率与对照组感染发生率的比值计算发生率比值。

结果：所有严重感染的发生率比值为4.53（95%置信区间3.39-6.00）。上呼吸道感染的发生率比值最高8.88（3.54-25.9），难辨梭状芽胞杆菌感染5.35（1.54-23.8），非特异性败血症4.55（1.60-13.8）和皮肤感染5.35（1.69-19.8）。所有严重感染中，38.4%发生于诊断6个月内，30.2%发生于诊断后7-24月，31.4%发生于诊断24个月后。诊断时血清肌酐升高及高龄与严重感染相关（p＜0.001）。在严重感染者中，46.5%患者在随访中死亡，而无严重感染的患者26%死亡（p=0.004）。

结论：AAV患者严重感染的比例较正常人群明显升高，尤其年长及肾功能受损的患者。严重感染的风险在诊断血管炎的6个月内特别高。

附原文  

OBJECTIVE: To compare the rate of severe infections after the onset of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) with the rate in the background population, and to identify predictors of severe infections among patients with AAV.METHODS: The study cohort was 186 patients with AAV diagnosed from 1998 to 2010, consisting of all known cases in a defined population in southern Sweden. For each patient, 4 age- and sex-matched reference subjects were randomly chosen from the background population. Using the Skåne Healthcare Register, all International Classification of Diseases codes of infections assigned from 1998 to 2011 were identified. Severe infections were defined as infectious episodes requiring hospitalization. Rate ratios were calculated by dividing the rate in AAV by the rate among the reference subjects.RESULTS: The rate ratio for all severe infections was 4.53 (95% CI 3.39-6.00). The highest rate ratios were found for upper respiratory tract: 8.88 (3.54-25.9), Clostridium difficile: 5.35 (1.54-23.8), nonspecific septicemia 4.55 (1.60-13.8), and skin 5.35 (1.69-19.8). Of the severe infections, 38.4% occurred within 6 months of diagnosis, 30.2% from 7-24 months, and 31.4% after 24 months. High serum creatinine and older age at diagnosis were associated with severe infection (p < 0.001). Of those with severe infection, 46.5% died during followup compared to 26% of patients without severe infection (p = 0.004). CONCLUSION:Patients with AAV have markedly higher rates of severe infection compared with the background population, especially patients with older age and impaired renal function. The risk of severe infection is particularly high in the first 6 months following the diagnosis of vasculitis.

引自

Mohammad AJ, Segelmark M, Smith R, et al. Severe Infection in Antineutrophil Cytoplasmic Antibody-associated Vasculitis. J Rheumatol. 2017 Aug 1. pii: jrheum.160909. doi: 10.3899/jrheum.160909. [Epub ahead of print]