Clinical Features And Prognostic Effects Of Lung Imaging Changes Of ANCA-associated Small Vasculitis

Background:Pulmonary image changes are common in patients with ANCA-associated small vasculitis(AAV),and pulmonary fibrosis(PF)is becoming more and more important.At present,there are few studies on the performance of different lung images in AAV patients.The aim of this study was to analyze the data of patients with AAV in our center,and to obtain the characteristics of lung imaging changes and the prognostic effect of AAV patients.Methods:This study included a total of 136 patients diagnosed with AAV from the First Affiliated Hospital of Zhejiang University Medical College from March 2009 to December 2015.Initial general conditions,serological data,imaging studies,and follow-up and end-point data.According to whether the lung image was positive,the included patients were divided into two groups to compare and analyze the significant differences.The Kaplan-Meier survival curves were prepared by end-stage renal disease and death events to observe impact of lung image changes on the prognosis;According to the degree of lung lesion,we divided our patients with positive changes into different sub-groups to compare the differences between the lung imaging positive sub-groups.And then according to whether the outcome was end-stage renal disease or survive,the two groups were divided into two groups respectively,and were compared to get the indicators,which have an impact on patients with end-stage renal disease or survival,and then establish a COX regression model to obtain the two independent risk factors.Results:1.According to whether the patient’s lung image was changed,136 patients were divided into negative group and positive group.The number of cases was 43 cases(31.6%)and 93 cases(68.4%)respectively.According to the degree of imaging performance of 93 patients with lung image positive,the imaging group was divided into three subgroups,which were the only lung texture increase group,ground glass opacities change group and honeycombing change group,and there were 40 cases(43.0%),35 cases(37.6%)and 18 cases(19.4%),respectively.According to whether the outcome was end-stage renal disease,all patients were divided into two groups,non-end-stage renal disease group with 83 cases(61.02%)and end-stage renal disease group with 53 cases(38.97%).According to weather the outcome was survival,all patients were divided into two groups,survival group with 114 cases(83.82%)and death group with 22 cases(16.18%).End-stage renal disease is defined as continuous hemodialysis or peritoneal dialysis at least 6 weeks and renal function failed to recover.2.In the comparison of the initial data of the lung imaging positive group and the negative group,the age was significantly different,and the age of the lung imaging positive group was larger(P = 0.021).The levels of serum creatinine and CRP between the two groups were significantly different and were higher than those in the lung imaging group,serum creatinine(P = 0.019)and CRP(P = 0.022),respectively.There was no significant difference in renal pathology,treatment and prognosis.End-stage renal disease as the end event,the Kaplan-Meier survival curves were compared between the positive and negative groups(P = 0.045).Death as the end event,the Kaplan-Meier survival curves were compared between the positive and negative groups(P = 0.774).Further,lung imaging was divided into three subgroups,and subgroups were compared.The results were not significantly different from those of patient demographics,examination results,renal pathology,treatment and prognosis.3.There was a significant difference in hypertension,fever,and pulmonary imaging changes in the comparison of end-stage renal disease group and end-stage renal disease group.Among them,high blood pressure(P = 0.036)and lung image positive patients(P = 0.038)were significantly less than those in end stage renal disease group.Patients with fever are more in the former group,HB,PLT,GLO,Cr,eGFR,proteinuria and PTH were significantly different.The establishment of COX regression model found that the independent risk factors for end stage renal disease were proteinuria(P = 0.012)and eGFR(P = 0.07).In the comparison between the survival group and the death group,the survival time of the survival group was longer(P = 0.000).EGFR was significantly different(P = 0.001).The incidence of end-stage renal disease was significantly different(P<0.001).The establishment of COX regression model found that end stage renal disease was an independent risk factor for death.Conclusions:Lung image positive ANCA-associated small vasculitis patients with higher creatinine onset,prognosis of the kidney will be worse;But the severity of lung imaging positive performance had no significant effect on prognosis;Pulmonary image positive is not an independent risk factor for the prognosis of patients,Proteinuria,eGFR is an independent risk factor for the prognosis of end-stage renal disease.