PDF(Pubmed)
Abstract：
UNASSIGNED: Previous studies have identified the predictors of severe infections in ANCA-associated vasculitis. However, lymphopenia has not been fully evaluated as a predictor of subsequent severe infections in patients with microscopic polyangiitis (MPA). The aim of this study was to assess the association between lymphopenia and severe infections requiring hospitalization after receiving immunosuppressive therapy for MPA.
UNASSIGNED: This single-centre retrospective cohort study included 130 consecutive patients with newly diagnosed MPA from Aichi Medical University Hospital, Japan, who received immunosuppressive therapy between March 2004 and December 2020. The relationship between lymphopenia and subsequent severe infections was assessed using time-dependent multivariate Cox proportional hazard models adjusted for clinically relevant factors.
UNASSIGNED: During the follow-up period (median: 38 months; interquartile range: 15-63 months), 56 severe infectious episodes occurred in 51 patients (39.2%). Time-dependent multivariate Cox proportional hazard analyses identified older age [adjusted hazard ratio (HR) = 1.74 per 10 years, 95% CI: 1.13, 2.67], methylprednisolone pulse therapy (adjusted HR = 2.04, 95% CI: 1.03, 4.02), moderate lymphopenia (vs normal, adjusted HR = 7.17, 95% CI: 3.10, 16.6) and severe lymphopenia (vs normal, adjusted HR = 36.1, 95% CI: 11.8, 110.9) as significant predictors of severe infection.
UNASSIGNED: Lymphopenia is a predictor of subsequent severe infections in patients with MPA who receive immunosuppressive therapy. These results suggest the importance of sustained infection surveillance, particularly in older patients who develop lymphopenia during strong immunosuppressive therapy.
UNASSIGNED: This single-centre retrospective cohort study included 130 consecutive patients with newly diagnosed MPA from Aichi Medical University Hospital, Japan, who received immunosuppressive therapy between March 2004 and December 2020. The relationship between lymphopenia and subsequent severe infections was assessed using time-dependent multivariate Cox proportional hazard models adjusted for clinically relevant factors.
UNASSIGNED: During the follow-up period (median: 38 months; interquartile range: 15-63 months), 56 severe infectious episodes occurred in 51 patients (39.2%). Time-dependent multivariate Cox proportional hazard analyses identified older age [adjusted hazard ratio (HR) = 1.74 per 10 years, 95% CI: 1.13, 2.67], methylprednisolone pulse therapy (adjusted HR = 2.04, 95% CI: 1.03, 4.02), moderate lymphopenia (vs normal, adjusted HR = 7.17, 95% CI: 3.10, 16.6) and severe lymphopenia (vs normal, adjusted HR = 36.1, 95% CI: 11.8, 110.9) as significant predictors of severe infection.
UNASSIGNED: Lymphopenia is a predictor of subsequent severe infections in patients with MPA who receive immunosuppressive therapy. These results suggest the importance of sustained infection surveillance, particularly in older patients who develop lymphopenia during strong immunosuppressive therapy.
摘要：
■先前的研究已经确定了ANCA相关性血管炎中严重感染的预测因子。然而,在显微镜下多血管炎（MPA）患者中，淋巴细胞减少症尚未被完全评估为后续严重感染的预测因子。这项研究的目的是评估淋巴细胞减少症与接受MPA免疫抑制治疗后需要住院治疗的严重感染之间的关系。
■这项单中心回顾性队列研究纳入了爱知医科大学附属医院的130名连续新诊断的MPA患者，Japan,他们在2004年3月至2020年12月期间接受了免疫抑制治疗。使用根据临床相关因素调整的时间依赖性多变量Cox比例风险模型评估淋巴细胞减少与随后的严重感染之间的关系。
■在随访期间（中位数：38个月；四分位数范围：15-63个月），51例（39.2％）发生严重感染发作56例。时间依赖性多变量Cox比例风险分析确定年龄较大[调整后的风险比（HR）=1.74每10年，95%CI：1.13，2.67]，甲基强的松龙脉冲治疗（调整后的HR=2.04，95％CI：1.03，4.02），中度淋巴细胞减少症（与正常相比，调整后的HR=7.17，95%CI：3.10，16.6）和严重的淋巴细胞减少（与正常相比，调整后的HR=36.1，95%CI：11.8，110.9)是严重感染的显著预测因子。
■淋巴细胞减少是接受免疫抑制治疗的MPA患者随后发生严重感染的预测因素。这些结果表明持续感染监测的重要性，尤其是在强力免疫抑制治疗期间出现淋巴细胞减少的老年患者。
■这项单中心回顾性队列研究纳入了爱知医科大学附属医院的130名连续新诊断的MPA患者，Japan,他们在2004年3月至2020年12月期间接受了免疫抑制治疗。使用根据临床相关因素调整的时间依赖性多变量Cox比例风险模型评估淋巴细胞减少与随后的严重感染之间的关系。
■在随访期间（中位数：38个月；四分位数范围：15-63个月），51例（39.2％）发生严重感染发作56例。时间依赖性多变量Cox比例风险分析确定年龄较大[调整后的风险比（HR）=1.74每10年，95%CI：1.13，2.67]，甲基强的松龙脉冲治疗（调整后的HR=2.04，95％CI：1.03，4.02），中度淋巴细胞减少症（与正常相比，调整后的HR=7.17，95%CI：3.10，16.6）和严重的淋巴细胞减少（与正常相比，调整后的HR=36.1，95%CI：11.8，110.9)是严重感染的显著预测因子。
■淋巴细胞减少是接受免疫抑制治疗的MPA患者随后发生严重感染的预测因素。这些结果表明持续感染监测的重要性，尤其是在强力免疫抑制治疗期间出现淋巴细胞减少的老年患者。
