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

Abstract

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

CLC Number:

R 543

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.

References

[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.

Clinical characteristics and prognosis analysis of elderly patients with ANCA-associated vasculitis and positive antinuclear antibodies

PDF (PC)

Knowledge

Abstract

Cite this article

share this article

References

Related Articles 15

Metrics

Recommended 10

[1]	JIN Jingjing, GU Qiuli, LEI Jaiwei, WANG Jiahe. Research progress on drug targets for age-related hearing loss [J]. Practical Geriatrics, 2026, 40(2): 111-115.
[2]	LI Jiachun, YAN Li, LIU Jiye, SUN Weimin. Research progress on drug targets for sleep disorders in the elderly [J]. Practical Geriatrics, 2026, 40(2): 121-125.
[3]	LIU Beili, CHEN Yonghong, YE Shuai, ZHANG Bin, XIA Qing, SONG Bingyan, ZHU Junyong, JI Hongxia, WU Juan, MENG Qi, XU Xiachi. Effect analysis of etomidate combined with low dose esketamine in anesthesia induction of total hip arthroplasty in elderly patients [J]. Practical Geriatrics, 2026, 40(2): 132-135.
[4]	WANG Kun, XIE Jun. Predictive value of HALP score on the onset of frailty in the elderly patients with ischemic stroke [J]. Practical Geriatrics, 2026, 40(2): 142-146.
[5]	ZHANG Yang, YANG Shun, LU Ziru, SHA Lili. Analysis of the median effective dose and adverse effects of methylene blue combined with ropivacaine for fascia iliaca compartment block in postoperative analgesia in elderly patients undergoing hip arthroplasty [J]. Practical Geriatrics, 2026, 40(2): 154-158.
[6]	ZHONG Hailong, ZHONG Changzheng, ZHONG Qiong, WANG Kuiyuan, GUO Yanyan, HU Jianhua. Impact of artificial intelligence-assisted multi-cognitive domain training on elderly patients with mild cognitive impairment: a randomized controlled trial among community-dwelling elderly individuals [J]. Practical Geriatrics, 2026, 40(2): 159-163.
[7]	CAO Yaolin, HUANG Yuming, YANG Jinpeng, WANG Wei, ZHOU Yue, LI Menglan. Predictive study of lymph node metastasis in elderly patients with superficial esophageal squamous cell carcinoma [J]. Practical Geriatrics, 2026, 40(2): 169-173.
[8]	YAO Zitong, DANG Xiaoyu, FAN Haoling, ZHU Xiangyu, HUANG Jingjing, FENG Ganzhu. Research advances in hematologic impairments combined with respiratory viral infections in the elderly [J]. Practical Geriatrics, 2026, 40(2): 206-210.
[9]	LYU Jiajia, ZHONG Xiaoyou, GAO Yiteng, WANG Lin, FAN Weifei. Cancer pain management in the elderly: insights from the NCCN Guidelines Version 2.2025 Adult Cancer Pain [J]. Practical Geriatrics, 2026, 40(2): 211-216.
[10]	LI Yanlin, SUN Jinbing. Progress in diagnosis and treatment of constipation in the elderly [J]. Practical Geriatrics, 2026, 40(1): 11-15.
[11]	WANG Jinfeng, SONG Jiao, JIANG Yangyang, YANG Xue, LI Ying. Association between sleep quality and depressive symptoms in residents with cognitive impairment residing in nursing homes [J]. Practical Geriatrics, 2026, 40(1): 16-20.
[12]	LIU Mengjie, DU Qiuyao, CHEN Xiaoxiao, ZHANG Zequn, ZENG Yang, LEI Shiyu, ZHANG Qing. Predictive value of non-HDL-C/HDL-C for coronary artery calcification in older patients with type 2 diabetes mellitus [J]. Practical Geriatrics, 2026, 40(1): 21-25.
[13]	LU Yue, CHEN Jinjin, ZHU Chengyuan, ZHOU Liang, FENG Chun, LIN Feng. A decision-making tool for ICF-based community rehabilitation in elderly patients with chronic stroke incorporating difficulty and intervention benefit scales [J]. Practical Geriatrics, 2026, 40(1): 32-37.
[14]	BO Yun, WANG Qi, YANG Lianqianzi, ZHU Jinyu, ZHANG Yuanyuan. Association of sleep quality with frailty among adults aged 80 years and older in an integrated medical and long-term care institution [J]. Practical Geriatrics, 2026, 40(1): 38-42.
[15]	TAO Lu, XIA Zeyan. Association between frailty and apathy in community-dwelling elderly adults [J]. Practical Geriatrics, 2026, 40(1): 43-47.