摘要（英国） 目的 了解ANCA相关性血管炎患者诊断时临床特点与首次复发间的相关性。

方法 研究4个临床试验的长期随访资料，包括新诊断ANCA血管炎的严重性和表现，把基线时疾病和患者特点作为复发风险回归模型。

结果 总共有535例患者(1804患者年)评估复发风险。诊断时的平均年龄为60.7岁(四分位范围为48.8~69.1)，284例患者(53%)为韦格纳肉芽肿，肌酐中位值为203 μmol/L (四分位范围为97 - 498)，有211例(38%)患者复发，133例(25%)死亡，其中96例患者无复发便死亡。抗蛋白酶3抗体(亚风险比为1.62，95%可信区间为1.39~1.89)和心血管受累(风险比为1.59，95%可信区间为1.07~ 2.37)与复发高风险独立相关。与肌酐≤100 μmol/L的患者相比，肌酐值较高者的复发风险降低，肌酐值为101-200μmol/L和>200μmol/L的亚风险比分别为 0.81[95% CI 0.77-0.85]和0.39 [95% CI 0.22-0.69]。

讨论 :ANCA相关性血管炎复发多见。诊断时血肌酐>200 μmol与复发风险明显降低有关，也许有助于指导患者的监测和治疗。

附原文 Abstract OBJECTIVE: To determine the association between characteristics at diagnosis and the time to first relapse in a large cohort of patients with anti-neutrophil cytoplasm antibody associated vasculitis (AAV). METHODS: Long-term follow-up data from four clinical trials that included newly diagnosed patients with a broad spectrum of AAV severity and manifestations were studied. Patient and disease characteristics at baseline were used in competing risk regression models with relapse as the failure event and death as the competing event. RESULTS: 535 patients with 1804 patient-years at risk for relapse were assessed. At diagnosis the median age was 60.7 years (interquartile range [IQR] 48.8 - 69.1), 284 patients (53%) had granulomatosis with polyangiitis (Wegener's), and the median creatinine was 203 μmol/L (IQR 97 - 498). Two-hundred and one patients (38%) experienced a relapse and 133 patients (25%) died of whom 96 died without experiencing a relapse. Anti-proteinase 3 antibodies (subhazard ratio [sHR] 1.62; 95% confidence interval [CI] 1.39-1.89), and cardiovascular involvement (HR 1.59; 95% CI 1.07 - 2.37) were independently associated with a higher risk of relapse. Compared to patients with a creatinine ≤100 μmol/L, patients with a higher creatinine had a lower risk of relapse (sHR 0.81 [95% CI 0.77-0.85] for creatinine 101-200 and sHR 0.39 [95% CI 0.22-0.69] for creatinine >200). DISCUSSION: Relapse of disease is common for patients with AAV. A creatinine >200 μmol at the time of diagnosis is a strongly associated with a reduced risk of relapse and may help guide monitoring and treatment of patients with AAV.

引自：Walsh M, Flo?mann O, Berden A, Westman K, H?glund P, Stegeman C, Jayne D; on behalf of the European Vasculitis Study GroupRisk factors for relapse of ANCA associated vasculitis. Arthritis Rheum. 2011 Sep 27. doi: 10.1002/art.33361. [Epub ahead of print]