关键词: 抗中性粒细胞胞质抗体相关血管炎, 肾存活率, 危险因素

Abstract:

Ｏｂｊｅｃｔｉｖｅ：To investigate the prognosis and risk factor in ANCA associated vasculitis (AAV) with different renal pathologic classifications.
Ｍｅｔｈｏｄｏｌｏｇｙ：Two hundred five AAV patients with renal involvement, who were male 89 and female 116 with the age 52(37～59), were enrolled in this study. The baseline serum creatinine (SCr) was 43 mg/dl (IQR 22~66 mg/dl), 84(410%) of them needed renal replacement therapy (RRT). The renal pathologic classification was included focal (n=23), mixed (n=71), crescentic (n=47) and sclerotic (n=64) categories. The prognosis and risk factor of AAV with different renal pathologic classification were retrospectively studied. 
Ｒｅｓｕｌｔｓ：34 (405%) of patients with renal involvement got free from dialysis (median time one month), among them were 100%, 545%, 480% and 229% for the focal, mixed, crescentic and sclerotic categories, respectively. During a followup of 3~160 months (median time 22 months), 26 (127%) patients died, 92 (449%) developed end stage renal disease (ESRD). The renal survival at 5 years were 923%, 608%, 428% and 287% for the focal, mixed, crescentic and sclerotic categories, respectively (P<001). Cox multivariate analysis showed renal pathologic classification, SCr and lower albuminemia were independent risk factors for ESRD, focal (HR 01，P=001)、mixed (HR 04，P=0002) and crescentic (HR 05，P=0005) categories had less risk to ESRD with sclerotic category. Cox multivariate analysis showed SCr≥5 mg/dl (HR 49，P=000) and the ratio of normal glomeruli≤10% (HR 21，P=004) of sclerotic category had high risk to ESRD.
Ｃｏｎｃｌｕｓｉｏｎ：Renal survival was closely associated with pathologic classification, beside pathologic classification, SCr and albuminemia were the independent risk factor for AAV renal survival, and for sclerotic AAV, combined with SCr and the ratio of normal glomeruli could be more valuable.

Key words: antineutrophil cytoplasmic antibody associated vasculitis, renal survivalrisk,  , factor