Lung Involvement And Analysis Of The Prognosis In Patients With ANCA-associated Vasculitis

ObjectiveTo investigate the clinical characteristics of lung involvement in patients with ANCA-associated vasculitis,and analyze the risk factors of lung involvement and prognosis of ANCA associated vasculitis,so as to guide the clinical diagnosis and treatment as well as improving the prognosis of the patients.MethodsThis study retrospectively collected the clinical medical records of all patients who were diagnosed firstly in Hospital from September 1,2011 to December 1,2021,including general conditions,clinical manifestations,laboratory examinations,lung imaging examinations,etc.These patients were grouped according to clinical classification,serotype,lung involvement,age of onset and prognosis,whose clinical characteristics were copared.We also analyzed the characteristics of the patients with pulmonary hemorrhage,recurrent pulmonary infection and who were die.Logistic regression model was uesd to analyse the risk of AAV with lung involvement and death.Results1.There were 95 patients with AAV,including 50 females and 45 males,the average age of onset was 53.7 years old.There were 50 cases(52.6%)of respiratory infection,67 cases(70.5%)of lung injury,and 29 cases(30.5%)of respiratory system symptoms at the onset of the disease.The most common pulmonary imaging manifestations were nodules(20%)and interstitial pneumonia(15.8%).2.The incidence of Otolaryngology and eye involvement was higher in GPA group than in MPA group(83.3%vs 10.3%,P=0.001;33.3%vs 2.6%,P=0.043).The positive rate of urine protein in MPA group was higher than that in GPA group(82.1%vs 33.3%,P=0.025).The age of onset was higher in the death group than in the survival group(64.0±8.7 vs 52.4±17.1,P=0.002).The serum uric acid in survival group was higher than that in death group(P=0.047).The ESR in the death group was higher than that in the survival group(P<0.001).3.The clinical features of patients with pulmonary hemorrhage,recurrent pulmonary infection and death were described in detail.Univariate analysis showed that onset age≥60 years(OR:4.333,95%CI:1.071-17.539,P:0.040),erythrocyte sedimentation rate(OR:0.966,95%CI:0.935-0.999,P:0.043),and respiratory failure(OR:7.500,95%CI:1.420-39.605,P:0.018)were the risk factors for death of AAV patients.Symptoms of cough and sputum at the onset of the disease(OR:7.738,95%CI:1.691-35.418,P:0.008),platelet count(OR:1.004,95%CI:1.000-1.027,P:0.037),chest imaging examination suggested pleural effusion(OR:2.973,95%CI:1.069-8.270,P:0.037),pericardial effusion(OR:5.146,95%CI:1.111-23.840,P:0.036)and respiratory infection(OR:7.014,95%CI:2.494-19.727,P<0.001)were risk factors for lung involvement in AAV patients.ConclusionThe clinical manifestations of lung involvement in AAV patients are not specific,and early chest imaging examinations are difficult to distinguish from other lung diseases.If conditions permit,bronchoscopic alveolar lavage,lung function,lung biopsy and other examinations can be improved.Age of onset,respiratory failure and erythrocyte sedimentation rate were the risk factors for mortality of AAV patients,and respiratory infection was one of the factors leading to lung involvement in AAV patients.