激素联合吗替麦考酚酯治疗抗中性粒细胞胞质抗体相关血管炎肾脏损害患者的远期预后  

Corticosteroids combined with mycophenolate mofetil treatment on long-term outcome in anti-neutrophil cytoplasmic antibodies associated vasculitis with renal involvement

作　　者：陈樱花[1] 刘正钊[1] 杨柳[1] 章海涛[1] 刘志红[1] 胡伟新[1] 

机构地区：[1]南京军区南京总医院国家肾脏疾病临床医学研究中心全军肾脏病研究所,南京210016

出　　处：《肾脏病与透析肾移植杂志》2014年第4期307-313,共7页Chinese Journal of Nephrology,Dialysis & Transplantation

基　　金：国家科技支撑计划课题(2011BAI10B04)

摘　　要：目的：回顾性分析激素联合吗替麦考酚酯（MMF）治疗抗中性粒细胞胞质抗体（ANCA）相关血管炎（AAV）肾脏损害患者的远期预后. 方法：2000年1月至2012年6月确诊AAV伴活动性肾脏损害的患者51例（男21例,女30例）,平均年龄46.4±15.8岁,中位伯明翰系统性血管炎活动评分（BVAS） 13分,血清肌酐61.9～433.2 μmol/L（平均203.3±106.1 μmol/L）.所有患者均采用激素联合MMF（1～2.0 g/d）诱导治疗（其中14例予联合葡萄球菌A蛋白免疫吸附或双重血浆置换）,缓解后采用激素联合MMF（0.5～0.75 g/d）维持治疗.观察MMF治疗对AAV的临床疗效及远期人肾存活率. 结果：51例AAV患者随访3～ 155月（中位时间56月）,MMF治疗时间3～ 120月（中位时间23月）.诱导期1例死于肺部感染,1例进入终末期肾病（ESRD）,3例未缓解.46例（90.2％）获得缓解者进入维持治疗.随访期间3例因肺部感染死亡,3年和5年的人存活率均为93.2％.7例进入ESRD,3年和5年的肾存活率分别为91.8％和83.0％.共13例（28.3％）复发（中位复发时间43月）,其中10例肾脏复发,3例肾外复发.3年和5年的累积复发率分别为13.2％和25.6％.21例（41.2％）患者共发生不良反应29例次,包括感染27例次（肺部感染16例次）及血糖升高2例. 结论：激素联合MMF是AAV伴肾脏损害患者的有效治疗方法,肺部感染是该疗法的常见并发症及主要死亡原因,应加强肺部感染的预防.MMF治疗AAV的远期疗效仍需多中心、大样本临床对照试验来进一步验证.Objective：To retrospectively analyze the effects of corticosteroids with mycophenolate mofetil （MMF） treatment on long-term outcome in ANCA associated vasculitis （AAV） patients with renal involvement. Methodology： Fifty one AAV patients with renal involvement （male 21, female 30, average age 46. 4±15.8 years ） from January 2000 to June 2012 were enrolled in the study, The baseline median BVAS score was 13 and serum creatinine （SCr） was 203.3± 106. 1 txmolfL. All patients received corticosteroids in combined with MMF （ 1 -2. 0 g/d） for induction therapy, among them 14 patients received immunoadsorption （ n = 11 ） or double filtration plasmapheresis additionally （ n = 3 ）, after remission corticosteroids in combined with MMF was given continue for maintenance therapy. The clinical effects, patient and renal survival of corticosteroids with MMF in AAV with renal involvement were investigated. Results： The patients were treated with MMF for 3- 120 months （ median of 23 months） and had a follow-up time from 3 to 155 months （ median of 56 months）. In the induction stage with MMF, 46 （90. 2% ） patients achieved remission and went into the maintenance therapy, one died because of pulmonary infection, one developed to end stage renal disease （ ESRD ） , and 3 patients had no response to the therapy. During the follow-up, 3 patients died of pulmonary infection, the cumulative patient survival at 3 and 5 year was both 93.2%, and 7 patients developed to ESRD, the cumulative renal survival at 3 and 5year was 91.8% and 83.0%. 13 cases （28.3%） relapsed, the median relapse time was 43 months, accumulated relapse rate at 3 and 5 year was 13.2% and 25.6%. A total of 29 adverse reactions occurred in 21 （41.2%） patients, including infection （ n = 27） and hyperglycemia （n=2）, among them 16 were pulmonary infection. Conelusion：Corticosteroids with MMF was effective for treating AAV with renal involvement, while pulmonary infection was the common complication and caus

关 键 词：吗替麦考酚酯 血管炎 抗中性粒细胞胞质抗体 存活率 预后 

分 类 号：R692[医药卫生—泌尿科学]