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Michael Hendrickson¹, Anushri Parakh², Brittany Weber³

¹Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.

|January 6, 2025

概括

心血管疾病是ANCA相关血管炎 (AAV) 的一个主要风险. 许多AAV患者的冠状动脉 (CAC) 评分显著,表明心血管疾病风险高,但他类药物的使用不一致.

科学领域:

心脏病学心脏病学
类风湿病学类风湿病学
放射学放射学是指放射学

背景情况:

心血管疾病 (CVD) 是ANCA相关血管炎 (AAV) 的主要死亡原因.
积极查和初级心血管疾病预防策略对于改善AAV患者的治疗结果至关重要.
在CT扫描上冠状动脉 (CAC) 评分可以量化心血管疾病风险.

研究的目的:

评估ANCA相关血管炎 (AAV) 患者冠状动脉 (CAC) 的患病率和程度.
为了比较骨髓氧化酶-ANCA (MPO-ANCA) 和蛋白酶3-ANCA (PR3-ANCA) 阳性AAV患者之间的CAC负担.
评估在有显著CAC的AAV患者中使用他类药物治疗及其与主要心脏不良事件 (MACE) 的关联.

主要方法:

对175名来自Mass General Brigham AAV队列 (2002-2019) 的AAV患者进行了回顾性分析,并提供胸部CT扫描.
冠状动脉 (CAC) 评分和年龄,性别和种族标准化的CAC百分位数的计算.
量子回归用于比较ANCA类型的CAC;基于CAC分数的MACE差异格雷测试.

主要成果:

大多数患者 (65/175,39%) 的CAC得分≥100,表明临床显著的冠状动脉样硬化.
与PR3-ANCA阳性患者 (p<0.05) 相比,MPO-ANCA阳性AAV患者的中位数CAC得分 (24比1) 和百分位数 (50比34) 较高.
只有25% (29/116) 的非零CAC得分的患者被处方他类药物;更高的CAC得分趋向于增加MACE风险 (p=0.16).

结论:

在AAV人群中,临床意义上的冠状动脉是普遍存在的.
在MPO-ANCA和PR3-ANCA亚型之间存在CAC负担的差异.
在高CAC的AAV患者中,用于预防心血管疾病的不一致的他类药物使用,需要进一步调查CT引导查策略.

关键词:

心血管疾病心血管疾病结果评估,医疗保健血管炎是一种血管炎.

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