近半數AAV患者發生嚴重感染且與高齡及腎功能受損相關

AAV患者嚴重感染的比例較正常人群明顯升高，尤其年長及腎功能受損的患者。嚴重感染的風險在診斷血管炎的6個月內特別高。

摘 要

目的：比較抗中性粒細胞胞漿抗體（ANCA）相關性血管炎（AAV）患者和背景人群嚴重感染的發生率，並明確AAV患者嚴重感染的預測因素。

方法：這項研究隊列納入從1998年到2010年診斷的186例AAV患者，包括瑞典南部特定人群中的所有已知病例。對於每位患者，從背景人群中挑選4例年齡及性別與之相匹配的對照者。採用Skane衛生保健登記系統，明確所有從1998年到2011年感染性疾病的國際分類編碼。嚴重感染定義為需要住院治療的感染。AAV感染髮生率與對照組感染髮生率的比值計算髮生率比值。

結果：所有嚴重感染的發生率比值為4.53（95%置信區間3.39-6.00）。上呼吸道感染的發生率比值最高8.88（3.54-25.9），難辨梭狀芽胞桿菌感染5.35（1.54-23.8），非特異性敗血症4.55（1.60-13.8）和皮膚感染5.35（1.69-19.8）。所有嚴重感染中，38.4%發生於診斷6個月內，30.2%發生於診斷後7-24月，31.4%發生於診斷24個月後。診斷時血清肌酐升高及高齡與嚴重感染相關（p＜0.001）。在嚴重感染者中，46.5%患者在隨訪中死亡，而無嚴重感染的患者26%死亡（p=0.004）。

結論：AAV患者嚴重感染的比例較正常人群明顯升高，尤其年長及腎功能受損的患者。嚴重感染的風險在診斷血管炎的6個月內特別高。

原 文

Abstract

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 Sk?ne 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]

來源：中國風濕病公眾論壇

翻譯：北醫三院翟佳羽

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