抗中性粒细胞胞浆抗体相关血管炎并发肿瘤的危险因素分析  

Analysis of Risk Factors in Patients with Antineutrophil Cytoplasmic Antibody-Associated Vasculitis Complicated by Malignancy

作　　者：王小琪 季中菊 袁丹[1] 周晶晶 邵枫 李忠心[1] Wang Xiaoqi;Ji Zhongju;Yuan Dan;Zhou Jingjing;Shao Feng;Li Zhongxin(Department of Nephrology,Beijing Luhe Hospital,Capital Medical University,Beijing 101149,China)

机构地区：[1]首都医科大学附属北京潞河医院,北京市101149

出　　处：《中国病案》2025年第1期99-103,共5页Chinese Medical Record

基　　金：ANCA相关血管炎患者并发肿瘤的影响因素分析(LHYY2024-YJZ005)。

摘　　要：目的研究抗中性粒细胞胞浆抗体相关血管炎(ANCA-associated vasculitis,AAV)患者并发肿瘤的危险因素及临床特征,改善患者预后。方法采用回顾性研究方法,选取2018年1月1日-2023年12月31于某院住院治疗且保留完整数据的AAV患者,根据是否合并肿瘤分为2组,肿瘤组(有)和对照组(无),比较患者的临床特点。采用多因素Logistic回归法分析AAV患者发生肿瘤的影响因素。结果本研究共纳入125例AAV患者,平均年龄69.41±11.01岁,63例为男性,62例为女性。在这些AAV患者中,11例(8.8%)患有肿瘤,6例为结直肠癌,2例为肺癌,另外乳腺癌、间皮瘤以及前列腺癌各1例。与对照组相比,肿瘤组患者诊断肉芽肿性多血管炎的比例、蛋白酶3-ANCA抗体阳性率、初始诊断AAV时(4周内)伯明翰血管炎性活动性评分更高[54.5%对比13.2%;64.6%对比13.2%;23(19,29)对比16(11,21),均P<0.05,而随访期间的淋巴细胞计数绝对值以及血白蛋白平均值更低(0.80(0.50,1.07)对比1.44(1.10,1.77);30.0(28.7,34.1))对比35.0(31.4,38.1);均P<0.05]。多因素Logistic回归分析发现,初始诊断AAV时较高的BVAS评分以及随访期间淋巴细胞计数绝对值的平均值减低是AAV患者合并肿瘤的独立危险因素(P<0.05)。结论对于AAV患者易合并结直肠癌和肺癌,初始诊断AAV时较高的BVAS评分和随访期间LYM平均值减低是AAV患者合并肿瘤的独立危险因素。Objectives This study aims to explore the clinical characteristics and risk factors of cancer in patients with ANCA associated vasculitis(AAV) to improve patient outcomes. Methods A retrospective study method was used to select AAV patients who were hospitalized in a certain hospital from January 1, 2018 to December 31, 2023and had complete data. According to whether they were combined with tumors, the patients were divided into 2groups, tumor group(with) and control group(without), and their clinical characteristics were compared.Multivariate logistic regression was used to analyze the influencing factors of tumor occurrence in AAV patients.Results A total of 125 AAV patients were enrolled in this study, with an average age of 69.41±11.01 years. 63were males and 62 were females. Among these AAV patients, 11 patients(8.8%) were diagnosed with cancer,including 6 with colorectal cancer, 2 with lung cancer, 1 with breast cancer, 1 with mesothelioma, and 1 with prostate cancer. Compared with the control group, the tumor group had higher rates of granulomatosis with polyangiitis, positive rates of proteinase 3-ANCA antibodies, and Birmingham vasculitis activity score at the time of initial diagnosis of AAV(within 4 weeks)(54.5% vs. 13.2%;64.6% vs. 13.2%;23(19, 29) vs. 16(11, 21),all P<0.05), while the absolute value of lymphocyte count and mean value of serum albumin during follow-up were lower(0.80(0.50, 1.07) vs. 1.44(1.10, 1.77);30.0(28.7, 34.1) vs. 35.0(31.4, 38.1);all P<0.05).Multivariate logistic regression analysis found that a higher BVAS score at the time of initial diagnosis of AAV and a decrease in the average absolute value of lymphocyte count during follow-up were independent risk factors for tumors in AAV patients(P<0.05). Conclusions AAV patients are prone to colorectal cancer and lung cancer. A higher BVAS score at the initial diagnosis of AAV and a decrease in the average LYM score during follow-up are independent risk factors for tumors in AAV patients.

关 键 词：ANCA相关血管炎 恶性肿瘤 伯明翰血管炎性活动性评分 

分 类 号：R543[医药卫生—心血管疾病]