Chinese Medical Sciences Journal ›› 2022, Vol. 37 ›› Issue (4): 293-302.doi: 10.24920/004067
• Original Article • Previous Articles Next Articles
Yu Gu, Ting Zhang, Min Peng, Juhong Shi*()
Received:
2022-01-22
Accepted:
2022-07-12
Published:
2022-12-31
Online:
2022-08-24
Contact:
Juhong Shi
E-mail:shijh@pumch.cn
Yu Gu, Ting Zhang, Min Peng, Juhong Shi. Characteristics and Prognosis of Microscopic Polyangiitis Patients with Diffuse Alveolar Hemorrhage and Interstitial Lung Disease[J].Chinese Medical Sciences Journal, 2022, 37(4): 293-302.
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Figure 1.
The typical pulmonary presentations of MPA on HRCT. (A) The HRCT of a patient with DAH showed diffused ground-glass opacities; (B) Lung bases of an ILD patient showed reticular opacities with traction bronchiectasis corresponding to UIP pattern; (C) The HRCT of a patient with hemoptysis and decreased hemoglobulin showed ground-glass opacities and consolidation on the basis of UIP abnormality, indicating ILD combined with DAH. MPA: microscopic polyangiitis; HRCT: high-resolution computed tomography; DAH: diffused alveolar hemorrhage; ILD: interstitial lung disease; UIP: usual interstitial pneumonia."
Table 1.
Clinical characteristics of MPA patients with different pulmonary involvements (n = 181)"
Variable | DAH | DAH+ILD | ILD | NPI | Statistic | P value |
---|---|---|---|---|---|---|
No. of patients [n (%)] | 19 (10.5) | 18 (9.9) | 96 (53.0) | 48 (26.5) | ||
Age at diagnosis [yrs, median (range)] | 57 (47-65)a | 64 (59-75) | 69 (60-74)a | 65 (53-74) | H = 12.13 | 0.007 |
Male [n (%)] | 7 (36.8) | 8 (44.4) | 50 (52.1) | 20 (41.7) | χ2 = 2.378 | 0.498 |
Follow-up time [months, median (range)] | 54 (5-105) | 31 (3-78) | 50 (15-100) | 78 (57-112) | H = 2.545 | 0.058 |
BVAS [score, median (range)] | 22 (18-28) | 21 (12-25) | 21 (15-27) | 21 (15-29) | H = 1.955 | 0.582 |
FFS2009 [score, mean±SD] | 2.01±0.97 | 2.22±0.81 | 1.88±0.77 | 1.81±0.76 | H = 3.356 | 0.340 |
Fever [n (%)] | 4 (21.1) | 6 (33.3) | 25 (26.0) | 14 (29.2) | Fisher’s exact χ2=0.927 | 0.831 |
Weight loss [n (%)] | 6 (31.6) | 9 (50.0) | 48 (50.0) | 26 (54.2) | χ2 = 2.863 | 0.413 |
Organ involvement [n (%)] | ||||||
Renal | 18 (94.7) | 18 (100) | 83 (86.5) | 43 (89.6) | Fisher’s exact χ2=2.951 | 0.398 |
Nervous system | 5 (26.3) | 3 (16.7) | 40 (41.7) | 21 (48.3) | χ2 = 5.791 | 0.122 |
ENT | 2 (10.5) | 1 (5.6) | 14 (14.6) | 12 (25.0) | Fisher’s exact χ2=4.263 | 0.235 |
Skin | 4 (21.1) | 3 (16.7) | 10 (10.4) | 8 (16.7) | Fisher’s exact χ2=2.702 | 0.433 |
Cardiovascular system | 4 (21.1) | 3 (16.7) | 8 (8.3) | 3 (6.3) | Fisher’s exact χ2=4.589 | 0.171 |
Eyes | 1 (5.3) | 0 | 5 (5.2) | 5 (10.4) | Fisher’s exact χ?=2.294 | 0.467 |
Abdomen | 3 (15.8) | 1 (5.6) | 2 (2.1) | 3 (6.3) | Fisher’s exact χ2=6.237 | 0.064 |
Laboratory findings | ||||||
WBC [×??9/L, median (range)] | 10.1 (8.1-18.0) | 9.4 (7.9-13.7) | 10.0 (7.4-13.7) | 9.6 (6.8-12.8) | H = 2.510 | 0.473 |
HGB (g/L, mean±SD)* | 88±30b | 92±22 | 107±22b,c | 96±19c | F = 5.952 | 0.001 |
PLT (×109/L, median (range)) | 291 (209-429) | 228 (132-308) | 278 (194-363) | 260 (230-405) | H = 5.387 | 0.146 |
ESR (mm/h, mean±SD)* | 78 ± 40 | 73 ± 42 | 75±31 | 77±31 | F = 0.144 | 0.933 |
CRP (mg/L, median (range)) | 39 (18-70) | 21 (13-73) | 45 (10-91) | 58 (14-127) | H = 0.902 | 0.825 |
Creatinine [μmol/L, median (range)] | 449 (126-523)d,e | 357 (156-640)e | 123 (81-230)d | 170 (104-385) | H = 16.572 | 0.001 |
ANA [n (%)] | 28 (29.2) | 7 (38.9) | 7 (36.8) | 16 (33.3) | χ2 = 0.990 | 0.825 |
ANCA [n (%)] | Fisher’s exact χ2=10.309 | 0.185 | ||||
PR3/c-ANCA | 5 (5.3) | 0 | 2 (2.1) | 2 (4.2) | >0.05 | |
MPO/p-ANCA | 17 (89.5) | 16 (88.9) | 92 (95.8) | 44 (91.7) | >0.05 | |
MPO/p-ANCA+PR3/c-ANCA positive | 0 | 2 (11.1) | 1 (1.0) | 2 (4.2) | >0.05 | |
MPO/p-ANCA+PR3/c-ANCA negative | 1 (5.3) | 0 | 1 (1.0) | 0 | >0.05 | |
Treatments | ||||||
p-GC/h-GC/n-GC (n) | 8/11/0 | 8/10/0 | 20/73/3 | 17/31/0 | Fisher’s exact χ2=8.867 | 0.129 |
iv-CTX/po-CTX/n-CTX (n) | 11/4/4 | 11/4/3 | 53/33/10 | 25/15/8 | Fisher’s exact χ2=3.848 | 0.704 |
IVIG [n (%)] | 2 (10.5) | 5 (27.8)g | 3 (3.1)g | 3 (6.3) | Fisher’s exact χ2=11.062 | 0.005 |
PE [n (%)] | 3 (15.8) | 5 (27.8)h | 1 (1.0)h,i | 1 (2.1)i | Fisher’s exact χ2 =18.792 | <0.001 |
Prognosis [n (%)] | ||||||
Pulmonary infections in one year | 4 (8.2) | 4 (8.2) | 34 (69.4) | 7 (14.3) | Fisher’s exact χ2=7.590 | 0.051 |
Deaths in one year | 8 (42.1) | 7 (38.9) | 22 (22.9) | 9 (18.8) | Fisher’s exact χ2=5.870 | 0.115 |
Deaths overall | 11 (57.9) | 13 (72.2) | 58 (60.4) | 20 (41.7) | χ2 = 6.715 | 0.082 |
Figure 3.
The cumulative survival curve of MPA patients with different pulmonary involvement patterns. (A) The 3-month, 6-month, 1-year, 3-year and 5-year survival rates of 181 MPA patients were 81.8%, 77.3%, 74.6%, 61.9% and 51.9% respectively. (B) The 3-month, 6-month, 1-year, 3-year and 5-year survival rates of patients with both DAH and ILD were 100%, 66.7%, 33.3%, 27.8% and 27.8% respectively. The 3-month, 6-month, 1-year, 3-year and 5-year survival rates of DAH patients were 78.9%, 73.7%, 57.9%, 52.6% and 42.1% respectively. The 3-month, 6-month, 1-year, 3-year and 5-year survival rates of ILD patients were 82.3%, 78.1%, 77.1%, 59.4% and 46.9%."
Table 2.
Predictors of short-term prognosis of MPA patients analyzed by using multivariate Logistic regression"
Variables | Death in one year | Death in one month | |||||
---|---|---|---|---|---|---|---|
OR | 95%CI | P value | OR | 95%CI | P value | ||
Age | 1.047 | 1.009, 1.086 | 0.016 | 1.066 | 0.995, 1.142 | 0.080 | |
Male | 0.993 | 0.465, 2.121 | 0.905 | 0.537 | 0.113, 2.333 | 0.866 | |
Fever | 1.775 | 0.690, 4.566 | 0.302 | ||||
DAH | 2.164 | 0.864, 5.418 | 0.078 | 4.358 | 1.277, 14.877 | 0.019 | |
Cardiovascular system | 2.013 | 0.661, 6.129 | 0.145 | ||||
Skin/mucosa | 5.110 | 1.392, 18.758 | 0.014 | ||||
Abdomen | 3.744 | 0.419, 33.492 | 0.272 | ||||
WBC | 1.103 | 1.026, 1.186 | 0.008 | 1.103 | 1.008, 1.207 | 0.032 | |
HGB | 0.978 | 0.944, 1.014 | 0.240 | ||||
Creatinine | 1.002 | 1.000, 1.003 | 0.011 | 1.001 | 0.998, 1.004 | 0.430 |
Table 3.
Predictors of long-term prognosis of MPA patients analyzed with multivariate Cox and Logistic regression"
Variables | Cox regression | Logistic regression | |||||
---|---|---|---|---|---|---|---|
HR | 95%CI | P value | OR | 95%CI | P value | ||
Age | 1.044 | 1.023, 1.066 | <0.001 | 1.061 | 1.030, 1.094 | < 0.001 | |
Male | 0.803 | 0.539, 1.196 | 0.314 | 0.761 | 0.387, 1.497 | 0.366 | |
ILD | 1.389 | 0.904, 2.134 | 0.145 | 1.623 | 0.792, 3.324 | 0.185 | |
Cardiovascular system | 2.093 | 1.195, 3.665 | 0.010 | 6.216 | 1.260, 30.664 | 0.025 | |
WBC | 1.040 | 1.002, 1.079 | 0.039 | 1.024 | 0.955, 1.098 | 0.503 | |
HGB | 1.021 | 1.004, 1.038 | 0.016 | ||||
Creatinine | 1.001 | 1.000, 1.002 | 0.032 | 1.003 | 1.001, 1.005 | 0.003 |
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