Analysis of the association between age of onset with clinical features and long-term prognosis in patients with antineutrophil cytoplasmic antibody associated vasculitis
10.3760/cma.j.cn141217-20250317-00073
- VernacularTitle:抗中性粒细胞胞质抗体相关性血管炎患者发病年龄与临床特征和长期预后分析
- Author:
Xiujuan ZOU
1
;
Qian ZHANG
1
;
Yanyan WANG
1
;
Rui LIU
1
Author Information
1. 南京医科大学第一附属医院风湿免疫科，南京 210029
- Publication Type:Journal Article
- Keywords:
Anti-neutrophil cytoplasmic antibody-associated vasculitis;
Age of onset;
Prognosis;
Clinical features
- From:
Chinese Journal of Rheumatology
2025;29(11):923-929
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To analyze the clinical features and long-term prognosis of ANCA-associated vasculitis (AAV) patients with different onset ages.Methods:A total of 243 patients diagnosed with AAV at the First Affiliated Hospital to Nanjing Medical University from May 2009 to January 2025 were retrospectively analyzed. The patients were divided into the elderly group (age≥60 years old) and middle-aged and young patient group (age<60 years old) according to the age of onset. The baseline clinical characteristics and long-term prognosis of the two groups were compared, and the risk factors for progression to end-stage renal disease (ESRD) in elderly AVV patients were analyzed. The clinical characteristics and long-term prognosis of the two groups of patients were compared. The measurement data were analyzed by t-test or rank sum test, and the count data were analyzed by chi-square test. The risk factors for the progression of ESRD in elderly patients with AAV were analyzed by binary multivariate logistic regression. Results:A total of 243 AAV patients were included, among which 174 cases were microscopic polyangiitis (MPA) and 69 cases were granulomatosis with polyangiitis (GPA). In 157 elderly patients, with 72 cases female, 84.1%(132 cases) had MPA. Compared with young and middle-aged patients, renal involvement is more common in elderly patients with AAV [(eldrly group 133 cases, 84.7%) vs. middle-aged and young patient group: 61 cases(70.9%), χ2=6.557, P=0.010]. The proportion of patients with hypertension, thrombosis, stroke, coronary heart disease, and COPD was higher compared to non-elder patients ( P<0.05). Elderly patients with AAV have higher levels of IgA and serum creatinine. Kaplan-Meier survival analysis showed that compared with young and middle-aged patients, elderly AAV patients had a higher all-cause mortality rate within 1 year after disease onset and a higher risk of progressing to ESRD within 1 year ( P<0.05), while the levels of IgM, C3, C4, albumin, and hemoglobin were lower ( P<0.05). 86 patients were middle-aged and young patients, with 54 cases were female and 51.2%(44 cases) had GPA. Ear, nose, and throat involvement was more common than elder patients[elderly group: 26 cases(16.2%) vs. middle-aged and young patient group: 31 cases(36.0%), χ2=10.864, P=0.001]. The median follow-up duration was 18 (7, 60) months. Kaplan-Meier survival analysis showed that compared with middle-aged and young patients, elderly AVV patients had a higher all-cause mortality rate within 1 year after disease onset and a higher risk of progression to ESRD within 1 year ( P<0.05). Multivariate logistic regression analysis revealed that baseline serum creatinine level [ OR(95% CI)=1.008(1.003, 1.012), P<0.001] was an independent risk factor for progression to ESRD in elderly patients. Conclusion:Elderly patients with AAV have more severe organ damage, higher all-cause mortality within one year, and a higher risk of progression to ESRD within one year after disease onset close monitoring of high-risk elderly patients should be strengthened.
