抗中性粒细胞胞浆抗体相关性血管炎与肾功能衰竭救治的疗效评价  

Evaluation of therapeutic effects on ANCA-associated vasculitis and renal failure

作　　者：俞海瑾[1] 陈楠[1] 任红[1] 陈晓农[1] 张文[1] 徐耀文[1] 郝翠兰[1] 

机构地区：[1]上海第二医科大学附属瑞金医院肾内科,200025

出　　处：《中华肾脏病杂志》2001年第5期298-300,共3页Chinese Journal of Nephrology

基　　金：上海市医学领先专业重点学科资助项目(983009);上海市科委资助项目(994119015)

摘　　要：目的 评价抗中性粒细胞胞浆抗体相关性血管炎（ＡＳＶ）肾脏损害及救治疗效。方法１９９７．１０～２００１．３间确诊ＡＳＶ ５６例，急诊肾穿刺活检２１／５６例，依据病情活动度和病损程度分别予以双冲击、单冲击、单纯激素和（或）小剂量ＣＴＸ、单纯或联合血液净化，追踪缓解率。结果ＡＳＶ中肾累及率９６．４％，肾功能衰竭（肾衰）９１．１％，急性肾衰８２．ｌ％，重度肾衰４８．２％，病理以新月体性肾炎和局灶节段性肾炎常见。病死率１９．６％，缓解率６７．９％，失访率１２．５％。结论　ＡＳＶ患者肾损害发生率高，病情重；应强调“个体化”，早期治疗、合理干预，加强随访，急诊肾活检有助完善诊断；已进展至终末期者仍有免疫抑制剂应用指征。Objective To evaluate the renal involvement and therapeutic effect on ANCA-associated vasculitis(ASV) . Methods Fifty-six cases were diagnosed as ASV from Oct 1997 to Mar 2001. Among them, 21 cases received renal biopsies. According to disease activity and severity, Use following treatment protocols were choosed: (1) double pulse therapy; (2) single pulse therapy; (3) oral prednisone and/or low dose of CTX; (4) blood purification technique and/or immunosuppressive therapy. Remission rate was also analyzed. Results 96. 4% of case suffered with renal involvement. 91. 1% with acute renal failure, 96.4% with severe renal failure, 98. 2% with multiple organs involvement. The mortality was 19. 6% and the remission rate 67. 9%. 12. 5% of cases lost follow-up. Conclusions Renal involvement is common and serious in ASV patients. Individualized and early therapy, as well as valuable urgent renal biopsy are necessary. To those who have entered ESRD, immunosuppressive agents could be used to decrease the extra-renal complication.

关 键 词：抗中性粒细胞胞质抗体 血管炎 肾功能衰竭 治疗 疗效 

分 类 号：R692.5[医药卫生—泌尿科学] R543[医药卫生—外科学]