老年患者显微镜下多血管炎临床及生存分析

Clinical features and outcomes of microscopic polyangiitis in the elderly

摘要:

目的 探索老年人显微镜下多血管炎（MPA）的临床特点、转归和影响生存的因素。方法 入选2007年1月至2012年12月期间在北京协和医院确诊并住院治疗的MPA患者191例。按年龄分为两组：≥65岁组和＜65岁组。比较两组患者的临床资料，分析年龄对预后及生存的影响。对可能影响生存时间的因素进行Cox回归分析。结果 两组患者比较，＜65岁组以弥漫性肺泡出血（DAH）更为多见（P＝0.004）；≥65岁组则以肺间充质病变常见（P＝0.016）；≥65岁组患肾功能衰竭者明显多于＜65岁组（P＝0.033）；≥65岁组C?反应蛋白（CRP；P＝0.017）水平更高。采用Kaplan-Meier法绘制生存曲线，发现两组之间的生存函数差异有统计学意义（Log-rank＝10.462，P＝0.001）。行Cox单因素分析，显示年龄（HR：1.04，P＝0.002）、白细胞（HR：0.65，P＝0.000）、CRP（HR：1.01，P＝0.006）、肌酐（HR：1.00，P＝0.006）、尿素氮（HR：1.03，P＝0.002）、肺部感染（HR：5.57，P＝0.000）、DAH（HR：2.11，P＝0.007）和BVAS评分（HR：1.12，P＝0.000）与发生死亡相关。行Cox多因素分析，结果提示只有年龄（HR：1.02，P＝0.003）、肺部感染（HR：3.79，P＝0.040）、DAH（HR：5.02，P＝0.004）和BVAS评分（HR：1.10，P＝0.000）是发生死亡的高危因素。结论 MPA好发于老年人，无性别差异，高龄患者生存时间会明显缩短。

Abstract:

Objective To investigate the clinical features, outcome and influencing factors of microscopic polyangiitis (MPA) in the elderly patients. Methods Clinical data of 191 MPA patients admitted in our department from January 2007 to December 2012 were collected in this study. They were divided into ≥65 years old group and ＜65 years old group. Their clinical data were analyzed for the effect of age on the prognosis and survival. Cox regression analysis was employed to study the factors affecting survival. Results Diffuse alveolar hemorrhage (DAH) was more common in ＜65 years old group (P＝0.004), while interstitial lung disease in ≥65 years old group (P＝0.016) was more common. The incidence of renal failure (P＝0.033) and the serum level of C-reactive protein (CRP; P＝0.017) were significantly higher in ≥65 years old group than in ＜65 years old group . Kaplan-Meier survival analysis indicated that there was significant difference in the survival function between the 2 groups (Log-rank＝10.462, P＝0.001). Cox univariate analysis showed that age (HR: 1.04, P＝0.002), leukocytes (HR: 0.65, P＝0.000), CRP (HR: 1.01, P＝0.006), creatinine (HR: 1.00, P＝0.006), urea nitrogen (HR: 1.03, P＝0.002), pulmonary infection (HR: 5.57, P＝0.000), DAH (HR: 2.11, P＝0.007) and Birmingham Vasculitis Activity Score (BVAS; HR: 1.12, P＝0.000) were correlated with death. Cox multivariate analysis suggested that only age (HR: 1.02, P＝0.003), pulmonary infection (HR: 3.79, P＝0.040), DAH (HR: 5.02, P＝0.004) and BAVS score (HR: 1.10, P＝0.000) be high-risk factors for death. Conclusion MPA is common in the elderly, with no difference between genders. But the patients with older age have shorter survival time.