Analysis of clinical features and prognosis of antineutrophil cytoplasmic antibody with infection
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摘要:
目的 分析抗中性粒细胞胞质抗体相关性血管炎(anti-neutrophil cytoplasmic antibody-associated vasculitis, AAV)合并感染的临床特点,探讨影响感染发生的主要危险因素及感染对患者预后的影响。 方法 回顾性分析近6年蚌埠医学院第一附属医院收治的AAV患者118例,按是否感染分为感染组72例和非感染组46例,比较2组的临床资料,分析合并感染的临床特点,先使用单因素分析方法分析影响患者是否感染的危险因素,再使用logistic回归分析探讨影响感染发生的独立危险因素,绘制患者生存曲线,探讨感染对患者预后的影响。 结果 本组有61.02%的AAV患者合并感染,在感染组中发热、咳嗽咳痰、全身乏力、肌肉酸痛、ESR和CRP严重增快的患者显著增多,单因素分析显示2组高龄、白细胞计数增加、淋巴细胞计数减少、血红蛋白减少、白蛋白减低、C反应蛋白增高、血沉增快、电解质紊乱(血清钠离子浓度降低、血清氯离子浓度降低、血清钾离子浓度降低)、BVAS评分较高、使用环磷酰胺、合并心力衰竭、合并肺间质病变等比较差异有统计学意义(均P < 0.05),多因素分析表明淋巴细胞计数减少和血清钾离子浓度降低是影响AAV患者感染的独立危险因素(均P < 0.05);合并感染可显著缩短患者的生存期。 结论 AAV易合并感染,以呼吸道和细菌感染最为常见;常有多种危险因素导致AAV患者感染,其中淋巴细胞计数减少和血清钾离子浓度降低是AAV患者合并感染的独立危险因素;感染可加速患者死亡;积极防治感染可改善AAV患者的预后。 -
关键词:
- 抗中性粒细胞胞质抗体相关性血管炎 /
- 感染 /
- 危险因素 /
- 预后
Abstract:Objective To analyse the clinical characteristics of anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV) co-infection and to explore the main risk factors that affect the occurrence of infection and the impact of infection on the prognosis of patients. Methods A retrospective analysis was conducted on 118 AAV patients admitted to our hospital in the past 6 years. The patients were divided into the infected group (72 cases) and non-infected group (46 cases). The clinical data of the two groups were compared, and the clinical characteristics of co-infection were analysed. Single factor analysis was used to analyze the risk factors of infection. Then, logistic regression analysis was used to explore the independent risk factors that affect the occurrence of infection. The patient's survival curve was drawn, and the impact of infection on patient's prognosis was explored. Results About 61.02% AAV patients had co-infection, fever, cough and sputum, malaise, muscle aches and severely increased ESR and CRP. significant increase in the infected group. Univariate analysis showed that there was significant difference between the two groups in advanced age, increased white blood cell count, decreased lymphocyte count, reduced haemoglobin, reduced albumin, increased C-reactive protein, increased erythrocyte sedimentation rate, electrolyte disturbances (decreased serum sodium ion concentration, serum chloride ion concentration, serum potassium ion concentration), higher BVAS score, use of cyclophosphamide. Multivariate analysis showed that decreased lymphocyte count and decreased serum potassium ion concentration were independent risk factors affecting infection in AAV patients; co-infection could significantly shorten the survival period of patients. Conclusion AAV is prone to co-infection, with respiratory infections being the most common. Multiple risk factors often lead to infection in AAV patients, amongst which decreased lymphocyte count and serum potassium ion concentration are independent risk factors for co-infection. Infection can accelerate the death of patients. Active prevention and treatment of infection can improve the prognosis of AAV patients. -
表 1 感染组和非感染组临床特征比较[例(%)]
组别 例数 体温>38.5 ℃ 血小板增高 血沉>100 mm/h C反应蛋白>60 mg/L 伴咳嗽咳痰 伴全身乏力 伴肌肉酸痛 感染组 72 36(50.00) 37(51.38) 11(15.28) 42(58.33) 56(77.78) 30(41.76) 22(30.56) 非感染组 46 13(28.26) 10(21.74) 1(2.17) 17(36.96) 3(6.52) 5(10.87) 2(4.35) χ2值 5.463 10.269 3.939 5.130 57.005 12.760 11.898 P值 0.019 < 0.001 0.047 0.024 < 0.001 < 0.001 < 0.001 表 2 影响感染的单因素分析
组别 例数 年龄(x±s,岁) 白细胞计数(x±s,×109/L) 淋巴细胞计数(x±s,×109/L) 血红蛋白(x±s,g/L) 白蛋白(x±s,g/L) 球蛋白(x±s,g/L) C反应蛋白(x±s,mg/L) 感染组 72 67.93±9.20 11.44±4.80 1.20±0.49 89.03±18.12 30.76±4.50 33.22±6.18 66.80±51.37 非感染组 46 57.00±14.61 9.04±4.18 1.42±0.55 97.52±25.92 33.10±5.96 33.54±6.65 47.39±43.24 统计量 4.533a 2.789a -2.230a -2.094a -2.418a -0.266a 2.126a P值 < 0.001 0.006 0.028 0.038 0.017 0.791 0.036 组别 例数 血沉(x±s,mm/h) 钠离子浓度(x±s,mmol/L) 氯离子浓度(x±s,mmol/L) 钾离子浓度(x±s,mmol/L) 补体C3(x±s,g/L) 补体C4(x±s,g/L) BVAS评分(x±s,分) 感染组 72 70.96±27.94 135.66±5.28 99.24±5.77 3.82±0.73 0.72±0.22 0.18±0.07 19.07±5.73 非感染组 46 51.66±23.55 137.85±4.44 102.52±5.75 4.16±0.89 0.75±0.25 0.21±0.08 16.07±6.47 统计量 3.884a -2.327a -3.018a -2.252a -0.806a -1.759a 2.640a P值 < 0.001 0.022 0.003 0.026 0.422 0.081 0.009 组别 例数 血清肌酐[M(P25, P75),μmol/L] 肾小球滤过率[M(P25, P75), mL/(min·1.73 m2)] MP冲击治疗[例(%)] 环磷酰胺[例(%)] 心力衰竭[例(%)] 肺间质病变[例(%)] 感染组 72 289.17(74.25,394.50) 52.02(11.02,79.07) 9 (12.50) 25 (34.72) 33 (45.83) 41(56.94) 非感染组 46 339.22(64.00,476.50) 61.89(10.31,110.40) 6(13.04) 8(17.39) 9(19.57) 13(28.26) 统计量 -0.177b -0.701b 0.007c 4.185c 8.448c 9.304c P值 0.860 0.483 0.931 0.041 0.004 0.002 注:a为t值,b为Z值,c为χ2值。 表 3 发生感染的logistic多因素分析
变量 β SE Wald χ2 P值 OR值 95% CI 淋巴细胞计数 1.398 0.594 5.535 0.019 4.407 1.263~12.967 钾离子浓度 1.096 0.490 4.998 0.025 2.993 1.145~7.825 -
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