摘要

OBJECTIVE:The aim of our study was to assess major cardiovascular event incidence, predictors, and mortality in ANCA-associated vasculitis (AAV).
METHODS:We conducted a retrospective cohort study of all GPA or MPA, according to Chapel Hill Consensus Conference classification criteria, diagnosed between 1981 and 2015. Major cardiovascular event was defined as acute coronary artery disease, or ischemic stroke, or peripheral vascular disease requiring a revascularization procedure. We calculated the comparative morbidity/mortality figure (CMF) and we used Cox proportional hazards regression models to assess the risk of coronary artery disease, ischemic stroke associated with AAV, after adjusting for covariates.
RESULTS:125 patients, 99 GPA (79,2%) and 26 MPA (20,8%), were followed 88.4 ± 78.3 months. Ischemic stroke incidence was four times higher than in the general population (CMF 4,65; 95% CI 4,06-5,31). Coronary artery disease incidence was four times higher than in the general population (CMF 4,22; 95% CI 1,52-11,68). Smoking habits and history of coronary artery disease were strongly associated with coronary artery disease occurrence (adjusted HR 8.8; 95% CI 2.12-36.56, and adjusted HR 10.3; 95% CI 1.02-104.5, respectively). ENT flare-up was an independent protective factor for coronary artery disease occurrence. We did not identify factors significantly associated with stroke occurrence. The age-adjusted mortality rate was 22.5 per 1000 person-years. Mortality in AAV was 1.5 times higher than in the general population (CMF 1.56; 95% CI 1.34-1.83).
CONCLUSION:AAV have a significantly increased risk of mortality, ischemic stroke, and coronary artery disease.

译文

目的: 我们研究的目的是评估 ANCA 相关血管炎 (AAV) 的主要心血管事件发生率、预测因素和死亡率。
方法: 我们根据教堂山共识会议分类标准，对 1981年至 2015 间诊断的所有 GPA 或 MPA 进行了回顾性队列研究。主要心血管事件被定义为急性冠状动脉疾病，或缺血性中风，或需要血运重建程序的外周血管疾病。我们计算了比较发病率/死亡率 (CMF)，并在调整协变量后，使用 Cox 比例风险回归模型评估冠状动脉疾病、与 AAV 相关的缺血性中风的风险。
结果: 125 例患者，99 'gpa (88.4) 和 26' mpa ()，随访 ± 78.3 个月。缺血性中风的发病率比普通人群高四倍 (CMF 4,65; 95% CI 4,06-5,31)。冠状动脉疾病的发病率是普通人群的四倍 (CMF 4,22; 95% CI 1,52-11,68)。吸烟习惯和冠状动脉疾病史与冠状动脉疾病的发生密切相关 (调整后的 HR 8.8; 95% CI 2.12-36.56，调整后的 HR 10.3; 95% CI 1.02-104.5, 分别)。耳鼻喉炎是冠状动脉疾病发生的独立保护因素。我们没有确定与中风发生显著相关的因素。年龄调整后的死亡率为每 22.5 人年 1000 人。AAV 的死亡率是普通人群的 1.5 倍 (CMF 1.56; 95% CI 1.34-1.83)。
结论: AAV 显著增加了死亡率、缺血性中风和冠状动脉疾病的风险。