Disease Activity, Antineutrophil Cytoplasmic Antibody Type, and Lipid Levels in Antineutrophil Cytoplasmic Antibody-Associated Vasculitis

被引：25

作者：

Wallace, Zachary S. ^{[1
]}

Fu, Xiaoqing ^{[1
]}

Liao, Katherine ^{[2
]}

Kallenberg, Cees G. M. ^{[3
]}

Langford, Carol A. ^{[4
]}

Merkel, Peter A. ^{[5
]}

Monach, Paul ^{[6
]}

Seo, Philip ^{[7
]}

Specks, Ulrich ^{[8
]}

Spiera, Robert ^{[9
]}

St Clair, E. William ^{[10
]}

Zhang, Yuqing ^{[1
]}

Choi, Hyon ^{[1
]}

Stone, John H. ^{[1
]}

机构：

[1] Massachusetts Gen Hosp, Boston, MA 02114 USA

[2] Brigham & Womens Hosp, 75 Francis St, Boston, MA 02115 USA

[3] Univ Groningen, Groningen, Netherlands

[4] Cleveland Clin Fdn, 9500 Euclid Ave, Cleveland, OH 44195 USA

[5] Univ Penn, Philadelphia, PA 19104 USA

[6] VA Boston Hlth Care Syst Boston Vet Ctr, Boston, MA USA

[7] Johns Hopkins Univ, Baltimore, MD USA

[8] Mayo Clin, Rochester, MN USA

[9] Hosp Special Surg, 535 E 70th St, New York, NY 10021 USA

[10] Duke Univ, Sch Med, Durham, NC USA

来源：

ARTHRITIS & RHEUMATOLOGY | 2019年 / 71卷 / 11期

基金：

美国国家卫生研究院;

关键词：

CARDIOVASCULAR EVENTS; ANCA; PERFORMANCE; MANAGEMENT; RITUXIMAB; PROTEINS; INJURY; LDL;

D O I：

10.1002/art.41006

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Objective Patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) have an elevated risk of cardiovascular disease (CVD). This study was undertaken to develop a clearer understanding of the association between changes in disease activity and lipid levels in AAV, which may inform CVD risk stratification in this population. Methods Lipid levels were assessed in stored serum samples (obtained at baseline and month 6) from the Rituximab for ANCA-Associated Vasculitis (RAVE) trial, which randomized patients to receive either rituximab or cyclophosphamide followed by azathioprine. Paired t-tests and multivariable linear regression were used to assess changes in lipid levels. Results Of the 142 patients with serum samples available, the mean +/- SD age was 52.3 +/- 14.7 years, 72 (51%) were male, 95 (67%) were proteinase 3 (PR3)-ANCA positive, 72 (51%) had received a new diagnosis of AAV, and 75 (53%) were treated with rituximab. Several lipid levels increased between baseline and month 6, including total cholesterol (+12.4 mg/dl [95% confidence interval (95% CI) +7.1, +21.0]), low-density lipoprotein (+10.3 mg/dl [95% CI +6.1, +17.1]), and apolipoprotein B (+3.5 mg/dl [95% CI +1.0, +8.3]). These changes were observed among newly diagnosed and PR3-ANCA-positive patients but not among those with relapsing disease or myeloperoxidase-ANCA-positive patients. There was no difference in change in lipid levels between rituximab-treated patients and cyclophosphamide-treated patients. Changes in lipid levels correlated with changes in erythrocyte sedimentation rate but not with other inflammatory markers or glucocorticoid exposure. Conclusion Lipid levels increased during remission induction among patients with newly diagnosed AAV and those who were PR3-ANCA positive. Disease activity and ANCA type should be considered when assessing lipid profiles to stratify CVD risk in patients with AAV.

引用

页码：1879 / 1887

页数：9

共 35 条

[1] Circulating Cytokine Profiles and Antineutrophil Cytoplasmic Antibody Specificity in Patients With Antineutrophil Cytoplasmic Antibody-Associated Vasculitis [J].