Ученые выявили ключевые факторы риска легочных осложнений при антифосфолипидном васкулите

In antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV), the development of interstitial lung disease (ILD) is associated with older age, male gender, and myeloperoxidase (MPO)-ANCA positivity, while diffuse alveolar hemorrhage (DAH) may be linked to a pulmonary-renal pattern, according to a systematic review and meta-analysis published in Clinical Reviews in Allergy & Immunology. The development of ILD or DAH in AAV is associated with poor outcomes. Researchers attempted to identify the risk factors associated with such pulmonary involvement in order to support earlier diagnosis and monitoring of adults with AAV. The study authors searched for relevant studies published up to April 1, 2026, across 7 databases. Nineteen studies involving 2944 patients were included: 1329 had pulmonary involvement, and 1615 did not. Twelve studies examined ILD; 4 examined DAH. The authors performed univariate and multivariate meta-analyses and reported pooled odds ratios or mean differences with 95% confidence intervals. In the multivariate analysis, age over 65 years was associated with 3.60 times higher odds of ILD, while male gender was associated with 2.57 times higher odds. MPO-ANCA positivity was also more frequent among patients with ILD, with an odds ratio of 2.29 after adjustment. Several additional factors were associated with ILD only in univariate analyses. These included smoking history, microscopic polyangiitis subtype, cough, dyspnea, increased D-dimer, positive antinuclear antibodies, low C4, and elevated carbohydrate antigen 19-9. On the other hand, granulomatosis with polyangiitis subtype, proteinase 3-ANCA positivity, cytoplasmic-ANCA positivity, ear-nose-throat involvement, gastrointestinal involvement, and a higher Birmingham Vasculitis Activity Score (BVAS) were associated with a lower frequency of ILD. The evidence for DAH was less compelling as only 4 studies examined this outcome. In univariate analyses, proteinase 3-ANCA positivity and hemoptysis were more frequent in patients with DAH. DAH was also associated with proteinuria, a higher BVAS score, lower hemoglobin and C3 levels, and higher creatinine, blood urea nitrogen, and procalcitonin levels. For overall pulmonary involvement, older age, male gender, and a high BVAS score were independently associated with greater odds of lung disease. MPO-ANCA positivity was also more frequent among affected patients. “In clinical practice, high risk patients should be identified proactively based on the above factors. Through risk stratification, dynamic monitoring, and individualized interventions, the incidence of [pulmonary involvement] can be reduced, which is of great importance for preventing adverse outcomes associated with AAV related lung disease,” the study authors wrote. This article originally appeared on Rare Disease Advisor References: Yang Z, Wu Y, Chen Y, et al. Risk factors for pulmonary involvement in patients with ANCA-associated vasculitis: a systematic review and meta-analysis. Clin Rev Allergy Immunol. Published online July 31, 2026. doi:10.1007/s12016-026-09186-y