抗核抗体阳性的老年抗中性粒细胞胞质抗体相关性血管炎患者的临床特征及预后分析

doi:10.3969/j.issn.1003-9198.2026.02.007

摘要/Abstract

摘要： 目的探讨抗核抗体(ANA)阳性的老年抗中性粒细胞胞质抗体相关性血管炎(AAV)患者的临床病理特征及预后。方法回顾性分析2009年5月至2025年5月南京医科大学第一附属医院收治的99例60岁以上AAV患者临床资料,根据ANA检测结果分为阴性组和阳性组,比较2组基线特征、实验室指标、肾脏病理及临床预后。采用Kaplan-Meier生存曲线比较2组肾脏累积生存率,采用Cox比例风险回归模型分析AAV患者进展至终末期肾病(ESRD)的影响因素。结果 99例老年AAV患者的平均年龄为(70.9±5.9)岁,中位随访时间为16.0(6.0,44.3)个月,ANA阳性率为42.4%(42/99)。与ANA阴性组相比,ANA阳性组女性,合并高血压、高尿酸血症比例,血清IgG、IgA、尿酸、尿素、肌酐水平,1、5年进展至ESRD发生率更高,估算肾小球滤过率(eGFR)更低,差异均有统计学意义(P<0.05);肾活检病理特征显示ANA阳性组荧光染色IgG沉积强度加重(P=0.035);生存分析显示ANA阳性组肾脏累积生存率显著降低(P=0.014)。单因素Cox回归分析提示,ANA阳性是老年AAV患者进展至ESRD的危险因素(HR=2.84,95%CI: 1.16~6.98,P=0.023)。结论 ANA阳性是老年AAV患者肾功能损伤加重及ESRD风险升高的潜在标志,临床应加强对ANA阳性的老年AAV患者的肾功能随访与管理。

Abstract: Objective To investigate the clinicopathological characteristics and prognosis of elderly patients with antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitis (AAV) who were positive for antinuclear antibodies (ANA). Methods A retrospective analysis was conducted on the clinical data of 99 AAV patients aged over 60 years admitted to the First Affiliated Hospital with Nanjing Medical University from May 2009 to May 2025. Based on ANA test results, the patients were divided into ANA-negative group and ANA-positive group. Baseline characteristics, laboratory parameters, renal pathology, and clinical outcomes were compared between the two groups. Kaplan-Meier survival curves were used to compare the cumulative renal survival rates between the two groups, and the Cox proportional hazards regression model was used to analyze the influencing factors for progression to end-stage renal disease (ESRD) in AAV patients. Results The mean age of the 99 elderly AAV patients was (70.9±5.9) years, the follow-up time was 16.0 (6.0, 44.3) months, and the ANA-positive rate was 42.4%(42/99). Compared with the ANA-negative group, the ANA-positive group had a higher proportion of females, hypertension, and hyperuricemia; higher levels of serum IgG, IgA, uric acid (UA), urea, and creatinine; higher incidence rates of progression to ESRD at 1 and 5 years; and a lower estimated glomerular filtration rate (eGFR), and all these differences were statistically significant (P<0.05). Renal biopsy pathology characteristics showed increased intensity of IgG deposition in the ANA-positive group (P=0.035). Survival analysis showed that the cumulative renal survival rate was significantly lower in the ANA-positive group (P=0.014). Cox regression analysis indicated that ANA positivity was a risk factor for progression to ESRD in the elderly AAV patients (HR=2.84, 95%CI: 1.16-6.98, P=0.023). Conclusions ANA positivity is a potential marker for aggravated renal injury and increased risk of ESRD in the elderly AAV patients. Therefore, ANA-positive elderly AAV patients need more intensive renal follow-up.

Key words: anti-neutrophil cytoplasmic antibodies associated vasculitis, antinuclear antibody, clinical characteristics, end-stage renal disease, aged

中图分类号:

R 543

陆凤云, 张茜, 王艳艳, 刘蕊. 抗核抗体阳性的老年抗中性粒细胞胞质抗体相关性血管炎患者的临床特征及预后分析[J]. 实用老年医学, 2026, 40(2): 136-141.

LU Fengyun, ZHANG Qian, WANG Yanyan, LIU Rui. Clinical characteristics and prognosis analysis of elderly patients with ANCA-associated vasculitis and positive antinuclear antibodies[J]. Practical Geriatrics, 2026, 40(2): 136-141.

参考文献

[1] KRONBICHLER A, BAJEMA I M, BRUCHFELD A, et al. Diagnosis and management of ANCA-associated vasculitis[J]. Lancet, 2024, 403(10427): 683-698.
[2] GEETHA D, JEFFERSON J A. ANCA-associated vasculitis: core curriculum 2020[J]. Am J Kidney Dis, 2020, 75(1): 124-137.
[3] LI J, CUI Z, LONG J Y, et al. The frequency of ANCA-associated vasculitis in a national database of hospitalized patients in China[J]. Arthritis Res Ther, 2018, 20(1):226.
[4] BERTI A, FELICETTI M, MONTI S, et al. Disease and treatment-related morbidity in young and elderly patients with granulomatosis with polyangiitis and microscopic polyangiitis[J]. Semin Arthritis Rheum, 2020, 50(6): 1441-1448.
[5] 中国医师协会风湿免疫科医师分会自身抗体检测专业委员会. 抗核抗体检测的临床应用专家共识[J]. 中华检验医学杂志, 2018, 41(4): 275-280.
[6] SAVIGE J A, CHANG L, WILSON D, et al. Autoantibodies and target antigens in antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides[J]. Rheumatol Int, 1996, 16(3):109-114.
[7] LENERT P, ICARDI M, DAHMOUSH L. ANA (+) ANCA (+) systemic vasculitisassociated with the use of minocycline: case-based review[J]. Clin Rheumatol, 2013, 32(7): 1099-1106.
[8] ROBSON J C, GRAYSON P C, PONTE C, et al. 2022 American College of Rheumatology/European Alliance of Associations for Rheumatology classification criteria for granulomatosis with polyangiitis[J]. Ann Rheum Dis, 2022, 81(3):315-320.
[9] MUKHTYAR C, LEE R, BROWN D, et al. Modification and validation of the Birmingham Vasculitis Activity score (version 3)[J]. Ann Rheum Dis, 2009, 68(12): 1827-1832.
[10] EXLEY A R, BACON P A, LUQMANI R A, et al. Development and initial validation of the vasculitis damage index for the standardized clinical assessment of damage in the systemic vasculitides[J]. Arthritis Rheum, 1997, 40(2): 371-380.
[11] SETHI S, HAAS M, MARKOWITZ G S, et al. Mayo Clinic/Renal Pathology Society report on pathologic classification, diagnosis, and reporting of GN[J]. J Am Soc Nephrol, 2016, 27(5): 1278-1287.
[12] PEARCE F A, CRAVEN A, MERKEL P A, et al. Global ethnic and geographic differences in the clinical presentations of anti-neutrophil cytoplasm antibody-associated vasculitis[J]. Rheumatology: Oxford, 2017, 56(11): 1962-1969.
[13] REDONDO-RODRIGUEZ R, MENA-VÁZQUEZ N, CABEZAS-LUCENA A M, et al. Systematic review and meta analysis of worldwide incidence and prevalence of antineutrophil cytoplasmic antibody (ANCA) associated vasculitis[J]. J Clin Med, 2022, 11(9): 2573.
[14] 陈建, 牛艳慧, 李桂莲, 等. 抗中性粒细胞胞质抗体相关性血管炎190例临床特点分析[J]. 中华医学杂志, 2009, 89(36): 2548-2551.
[15] LI X, LIU X, CUI J, et al. Epidemiological survey of antinuclear antibodies in healthy population and analysis of clinical characteristics of positive population[J]. J Clin Lab Anal, 2019, 33(8): e22965.
[16] 何娅, 田梅. 常见自身抗体在自身免疫性疾病中的研究进展[J]. 海南医学, 2020, 31(3): 360-364.
[17] SATOH M, CHAN E K L, HO L A, et al. Prevalence and sociodemographic correlates of antinuclear antibodies in the United States[J]. Arthritis Rheum, 2012, 64(7): 2319-2327.
[18] ROVETA A, PARODI E L, BREZZI B, et al. Lupus nephritis from pathogenesis to new therapies: an update[J]. Int J Mol Sci, 2024, 25(16): 8981.
[19] 中国医师协会肾脏内科医师分会. 中国肾脏疾病高尿酸血症诊治的实践指南(2017版)[J]. 中华医学杂志, 2017, 97(25): 1927-1936.
[20] YANAI H, ADACHI H, HAKOSHIMA M, et al. Molecular biological and clinical understanding of the pathophysiology and treatments of hyperuricemia and its association with metabolic syndrome, cardiovascular diseases and chronic kidney disease[J]. Int J Mol Sci, 2021, 22(17): 9221.
[21] 叶朝阳, 崔琳琳. 老年人肾脏变化及功能评估[J]. 中华肾病研究电子杂志, 2015, 4(4): 182-186.