目的:探讨抗肾小球基底膜抗体(抗GBM)和抗中性粒细胞胞浆抗体(ANCA)双血清阳性(DPP)患者的临床特点。
方法:收集2010年1月至2022年8月在南京医科大学第一附属医院肾内科住院的ANCA和抗GBM阳性肾小球肾炎患者。回顾性分析患者的基线临床特征并进行随访,探讨影响肾脏及患者生存的相关因素。
结果:共386名患者,包括69例ANCA阴性抗GBM肾小球肾炎患者,296例抗GBM阴性ANCA相关性血管炎(AAV)患者,21DPP纳入本研究。在21名68.0岁(59.5、74.0)的DPP中,有11名男性和10名女性。诊断时血清肌酐中位数为629.0(343.85,788.75)μmol/L,中位eGFR(CKD-EPI)为7.58(4.74,13.77)mL/min。15例(71.4%)行初始RRT。经过40.0(11.0,73.0)个月的随访,21个DPP中有13个(61.9%)接受了维护RRT,69例(71.0%)ANCA阴性抗GBM-GN患者和296例(41.9%)抗GBM阴性AAV患者中的124例接受了维持性RRT(P<0.001)。Kaplan-Meier生存分析显示,与抗GBM阴性AAV患者相比,DPPs和ANCA阴性抗GBM-GN患者更容易进展为ESRD(P=0.001)。在21例DPPs患者中,初始肾功能较好的患者的肾生存率明显较好,包括那些没有接受初始RRT的人(P=0.003),血清肌酐水平较低(Cr<629.0μmol/L,P=0.004)和更高的eGFR水平(eGFR≥7.60ml/min,P=0.005)比那些初始肾功能差的人。在后续行动结束时,21例DPP中有14例(66.7%)存活。生存分析显示DPPs组患者之间无显著差异,ANCA负反GBM-GN组,和抗GBM阴性AAV组。
结论:DPPs和ANCA阴性抗GBM-GN患者比抗GBM阴性AAV患者更有可能进展为ESRD。在DPP中,诊断时肾功能差可能是与肾生存率差相关的危险因素.
OBJECTIVE: To explore the clinical characteristics of double-seropositive patients (DPPs) with anti-glomerular basement membrane (Anti-GBM) antibodies and anti-neutrophil cytoplasmic antibodies (ANCA).
METHODS: We collected patients with both ANCA and anti-GBM positive glomerulonephritis who were hospitalized in the Department of Nephrology at the First Affiliated Hospital of Nanjing Medical University from January 2010 to August 2022. Retrospective analysis of the baseline clinical characteristics of patients and follow-up to explore relevant factors affecting renal and patient survival.
RESULTS: A total of 386 patients, including 69 ANCA negative anti-GBM glomerulonephritis patients, 296 anti-GBM negative ANCA associated vasculitis (AAV) patients, and 21 DPPs were enrolled in this study. Among the 21 DPPs aged 68.0 years (59.5, 74.0), there were 11 males and 10 females. The median serum creatinine at diagnosis was 629.0 (343.85, 788.75) μmol/L, and the median eGFR (CKD-EPI) was 7.58 (4.74, 13.77) mL/min. Fifteen cases (71.4 %) underwent initial RRT. After a follow-up of 40.0 (11.0, 73.0) months, 13 out of 21 DPPs (61.9 %) received maintenance RRT, while 49 out of 69 (71.0 %) ANCA negative anti-GBM-GN patients and 124 out of 296 (41.9 %) anti-GBM negative AAV patients received maintenance RRT (P < 0.001). Kaplan-Meier survival analysis showed that DPPs and ANCA negative anti-GBM-GN patients were more likely to progress to ESRD than anti-GBM negative AAV patients (P = 0.001). Among the 21 patients with DPPs, renal survival was significantly better in patients with better initial renal function, including those who did not receive initial RRT (P = 0.003), with lower serum creatinine levels (Cr < 629.0 μmol/L, P = 0.004) and higher eGFR levels (eGFR ≥ 7.60 ml/min, P = 0.005) than those with poor initial renal function. At the end of follow-up, 14 out of 21 DPPs (66.7 %) survived. Survival analysis showed no significant difference among patients in DPPs group, ANCA negative anti-GBM-GN group, and anti-GBM negative AAV group.
CONCLUSIONS: DPPs and ANCA negative anti-GBM-GN patients were more likely to progress to ESRD than anti-GBM negative AAV patients. In DPPs, the poor renal function at diagnosis might be a risk factor associated with poor renal survival.