老年嗜酸性肉芽肿性多血管炎患者临床特点及预后

Clinical features and prognosis of eosinophilic granulomatosis with polyangiitis in the elderly

摘要:

目的 年龄是影响抗中性粒细胞胞浆抗体相关性血管炎预后的重要因素,但针对老年嗜酸性肉芽肿性多血管炎(EGPA)患者的研究较为缺乏,本研究旨在探索老年EGPA患者的临床特点及预后影响因素。方法 回顾性分析2000年1月至2015年12月于北京协和医院确诊的EGPA患者,将患者分为老年组(年龄≥60岁)及非老年组(年龄<60岁)。依据不同数据类型,分别采用独立样本t检验、Mann-Whitney U 检验、卡方检验对2组患者症状特征、实验室检查及全因死亡方面的差异进行比较。采用Cox回归分析筛选死亡预测因素,采用Kaplan-Meier法估算累计生存率并绘制生存曲线。采用SPSS 25.0统计软件进行数据分析。结果 共纳入181例患者,其中老年组45例,非老年组136例。与非老年组患者比较,老年组患者血清肌酐浓度更高[(91.3±57.6)和(79.0±75.6)μmol/L; P=0.022],血红蛋白水平更低[(120.5±20.1)和(134.7±50.0)g/L; P=0.007],血沉更高[(51.5±37.0)和(35.5±36.8) mm/h; P=0.004],肾功能衰竭发生率更高(24.4％ 和 5.1％; P <0.001),血管炎活动度评分更高[(17.1±6.7) 和(14.2±6.9)分；P=0.016],五因子评分≥2分者比例更高(40.0％和8.8％; P<0.001)；全因死亡率显著增高(24.4％和 9.6％;P=0.011)。年龄≥60岁、心肌病、中枢神经系统受累、消化道出血以及使用免疫抑制剂治疗为EGPA患者死亡的危险因素。对于年龄≥60岁EGPA患者,肺栓塞及激素冲击治疗与死亡相关。结论 年龄≥60岁为EGPA患者死亡的独立危险因素。肺栓塞以及激素冲击疗法对老年EGPA患者预后带来的不利影响应引起临床医师的关注。

Abstract:

Objective Age is an important factor influencing the prognosis of anti-neutrophil cytoplasmic antibody-associated vasculitis. This study aimed to investigate the clinical features and prognostic factors influencing the treatment outcome of eosinophilic granulomatosis with polyangiitis (EGPA) in the elderly. Methods Clinical data of all patients diagnosed with EGPA at Peking Union Medical College Hospital from January 2000 to December 2015 were collected and retrospectively analyzed. The patients were divided into the elderly group (≥ 60 years old at diagnosis) and the non-elderly group (< 60 years old at diagnosis). Clinical features, results of laboratory tests, and all-cause mortality were compared between the 2 groups by independent samples t test, Mann-Whitney U test, Chi-square test according to different types of data. Cox proportional hazards modeling was used to assess the prognostic factors for mortality, and Kaplan-Meier survival analysis to estimate cumulative survival rate and draw survival curve. SPSS statistics 25.0 was used for data analysis. Results A total of 181 patients were enrolled, including 45 elderly patients (elderly group) and 136 non-elderly patients (non-elderly group). The elderly group had significantly higher serum creatinine concentration [(91.3±57.6) vs (79.0±75.6) μmol/L; P=0.022], lower hemoglobin level [(120.5±20.1) vs (134.7±50.0) g/L; P=0.007], higher erythrocyte sedimentation rate [(51.5±37.0) vs (35.5±36.8) mm/h; P=0.004], higher incidence of renal failure (24.4% vs 5.1%; P<0.001), and higher score of Birmingham vasculitis activity [(17.1±6.7) vs (14.2±6.9) points; P=0.016] when compared with the non-elderly group. The proportion of the patients with five-factor score ≥ 2 was significantly greater (40.0% vs 8.8%; P<0.001) in the elderly group than the non-elderly group, so was all-cause mortality (24.4% vs 9.6%; P=0.011). Age ≥60 years, cardiomyopathy, central nervous system involvement, gastrointestinal bleeding and immunosuppressive therapy were risk factors for mortality in the EGPA patients. Pulmonary embolism and methylprednisolone pulse therapy were associated with death for those ≥60 years old. Conclusion Age ≥ 60 years is an independent risk factor for death in EGPA patients. Clinicians should concern the adverse effects of pulmonary embolism and methylprednisolone pulse therapy in elderly EGPA patients.