Sphingosine-1-phosphate In Anti-neutrophil Cytoplasmic Antibody-associated Vasculitis: Coagulation-related Clinical Indicators And Complications

Background: Anti-neutrophil cytoplasmic antibody(ANCA)associated small vasculitis(ANCA-associated vasculitis,AAV)is a vascular disease with low incidence,high recurrence rate and mortality.The disease can produce myeloperoxidase(MPO)and proteinase-3(PR3)under the stimulation of pathogens,which eventually triggers neutrophil oxygen burst and degranulation.Previous studies have shown that plasma levels of sphingosine-1-phosphate(S1P)in AAV patients are not only significantly increased,but also related to disease activity.S1 P can cause neutrophil activation in the pathogenesis of AAV,producing ANCA and thrombin.Therefore,we speculate that there is a relationship between S1 P and hypercoagulability in AAV patients.Objective:By analyzing the relationship between the plasma S1 P level in patients with AAV and clinical coagulation indexes and clinical complications related to coagulation(thromboembolism,cerebral ischemia,cerebral hemorrhage),it can be concluded that the plasma S1 P level is related to the hypercoagulable state of the patients.Specific analysis of plasma S1 P levels and serum creatinine(Scr),estimated glomerular filtration rate(e GFR),Birmingham system vasculitis activity score(BVAS),blood coagulation in patients with AAV Prothrombin time(PT),partial thromboplastin time(APTT),thrombin time(TT),fibrinogen(FIB),fibrinogen reduction product(fibrinogen reduction product,FDP),D-dimer,C-reactive protein(CRP),platelets(PLT),and clinically related coagulation-related complications.Methods: A total of 40 patients who were diagnosed with AAV in the Department of Nephrology of the Affiliated Hospital of Inner Mongolia Medical University from December 2017 to October 2019 and healthy healthy volunteers were collected.TT,FDP,D-dimer,PLT,Scr and CRP levels.At the same time,BAVS scores were given to AAV patients.The clinical coagulation-relatedcomplications of AAV patients are counted through clinical auxiliary testing after admission.Among them,cerebral infarction and myocardial infarction are classified as thromboembolism.Results: 1.The plasma S1 P level in AAV patients is significantly higher than that of healthy volunteers;2.The plasma S1 P level in AAV patients is negatively correlated with e GFR levels(P = 0.022,r =-0.306);3.The plasma S1 P level in AAV patients is related to BVAS and PLT It was positively correlated with D-dimer level(P = 0.004,r =0.443;P <0.001,r = 0.654;P = 0.006,r = 0.427).40 patients with AAV were divided into 4groups: 28 patients without coagulation complications,6 patients with thromboembolism,4patients with cerebral ischemia,and 2 patients with cerebral hemorrhage.The plasma S1 P levels of patients with thromboembolism were compared with other Comparison of three groups(thromboembolic patients vs patients without coagulation complications,P = 0.025;thromboembolic patients vs cerebral ischemia patients,P = 0.048;thromboembolic patients vs cerebral hemorrhage patients,P = 0.006),of which The S1 P level is the highest.Conclusion:Plasma S1 P levels in AAV patients are related to e GFR,BVAS,PLT,D-dimer levels and the occurrence of thromboembolic events.