Clinical Characteristics And Outcome Of Patients With Anti-neutrophilic Cytoplasmic Antibodies-associated Vasculitis And The Relationship With Neutrophil-to-lymphocyte Ratio

Part I Clinical Characteristics and Outcome of Patients with Anti-Neutrophilic Cytoplasmic Antibodies-associated VasculitiesObjective To analyze the clinical characteristics and prognosis of patients with anti-neutrophilic cytoplasmic antibodies(ANCA)-associated vasculities(AAV).Methods 102 AAV patients diagnosed in the Second Affilication Hospital of Anhui Medical University,from August 2012 till June 2016 by retrieving the medical database.Demographic data,clinical and laboratory findings were recorded,and the prognosis was followed up.According to ANCA target antigens,MPO-ANCA positive group and PR3-ANCA positive group were divided into two groups.Results(1)Clinical Characteristics: The data of 102 patients with ANCA-associated vasculitis were enrolled with 63.2 ±16.7 average age,57 cases(55.88%)were over 65 years old.87 cases(82.59%)were MPO-ANCA positive,13 cases(12.75%)were PR3-ANCA positive and 2 cases(1.96%)were both positive.The patients had multisystem involvements.The most commonly involved organs were kidneys(84 cases)and lungs(72 cases).Among them,the rate of renal involvement in PR3-ANCA positive patients was significantly higher than that in MPO-ANCA positive patients(83.91% vs 76.92%,P<0.01),but there was no significant difference in extra organ involvement,such as lung,nervous system,cardiovascular system and digestive system(all P>0.05).(2)The levels of leukocyte,neutrophil and serum creatinine in MPO-ANCA positive group were significantly higher than those of PR3-ANCA positive ones(8.40±4.51 vs 5.90±3.04,P=0.047;6.25±3.98 vs 3.23±1.13,P=0.012;206(109,508)vs 81(52.25,311),P=0.041;respectively),the levels of lymphocyte,C3 and C4 in MPO-ANCA positive group were lower than those of PR3-ANCA positive ones(1.03±0.54 vs 1.28±0.53,P=0.035;0.17±0.10 vs 0.28±0.13,P=0.045;respectively),and the difference was statistically significant(P<0.05).(3)The average follow-up time was 30.33±16.21 months,among the 102 patients,forty-three(42.16%)patients complete remission,25 cases of hemodialysis(24.51%),9 cases of peritoneal dialysis(8.82%),there were 25 deaths(24.51%),of which 15 cases died of severe infection,8 cases died of acute myocardial infarction or acute left heart failure.Conclusions The most frequently involved organs in AAV are kidney and lung,and MPO-ANCA positive people are more susceptible to renal damage than those with PR3-ANCA positive.The cause of the disease is severe infection,acute myocardial infarction or acute left heart failure.Part II Neutrophil-to-lymphocyte ratio was associated with disease activity in patients with Anti-Neutrophilic Cytoplasmic Antibodies-associated VasculitiesObjective To investigate the the significance of the ratio of peripheral blood neutrophil to lymphocyte(NLR)in patients with ANCA-associated vasculitis(AAV).Methods 102 AAV patients diagnosed in the Second Affilication Hospital of Anhui Medical University,from August 2012 till June 2016 by retrieving the medical database.Demographic data,clinical manifestations and laboratory findings were recorded.Analyzed the correlation between NLR and AAV disease activity.Results(1)The total leukocyte,neutrophil,platelet,NLR,serum albumin,Scr,Ig G,Ig A,CRP,ESR,BVAS and 24 h urinary protein were obviously higher in AAV patients than those in healthy controls.The peripheral blood lymphocytes,complement C3 and C4 were lower than the healthy control group(P <0.05).(2)Patients with AAV were divided into low NLR group(NLR <4.25)and high NLR group(NLR> 4.25)with a median NLR of 4.25.Comparison of clinical data between low-NLR group and high-NLR group: The incidence of renal involved,pulmonary involved and fever-onset clinical manifestations was higher in the high NLR group than in the low NLR group(P = 0.03,0.006 and 0.037,respectively).The incidence of ENT involvement and weight loss was the first clinical manifestation,the incidence of low NLR group was significantly higher than the high NLR group(P = 0.041,0.036,respectively).There was no distinct difference in the incidence of clinical symptoms between the two groups in terms of age of onset,gender,nervous system involvement,cardiovascular system involvement,digestive system involvement,joint pain and skin rash(P> 0.05).(3)Compared with the laboratory indexes of low NLR group and high NLR group,the total number of leukocytes,neutrophils,CRP,ESR,Ig G,Ig M,Scr,BVAS and 24 h urinary protein in high NLR group were significantly higher than those in low NLR Group,while the levels of C3 in peripheral blood were lower than those in the low NLR group(all P <0.05).(4)In AAV patients,NLR was positively correlated with total leukocyte level(r =0.544,P<0.001),CRP(r =0.537,P<0.01),ESR(r =0.309,P=0.004)Scr(r =0.254,P=0.011)and BVAS(r =0.357,P<0.01).NLR was negatively correlated with C3(r =-0.2,P=0.046)and C4(r =-0.199,P=0.047).(5)ROC revealed that the level of NLR was superior to the level of CRP or ESR to distinguish active and inactive AAV.The area of ROC curve was 0.748(P<0.001)and the sensitivity and specificity were 66.7% and 85.3% when the cut-off point of NLR was 5.23.Conclusion The increase in the ratio of neutrophils to lymphocyte is a risk factor for AAV,and is positively related to the degree of disease activity of AAV.