激素冲击和联合血浆置换治疗ANCA相关性血管炎的疗效比较  

Comparison of the efficacy of high dosage methylprednisolone and plasmapheresis treatment in patients with ANCA associated vasculitis

作　　者：白培进 张勇[1] 李俊霞[1] 林强[1] 俞国庆[1] 王欢欢[1] 周欣谕 陈建[1] 

机构地区：[1]福建医科大学福总临床医学院(南京军区福州总医院)肾内科,福州350025

出　　处：《中华肾脏病杂志》2015年第2期97-101,共5页Chinese Journal of Nephrology

摘　　要：目的回顾性对照研究单独激素冲击和联合血浆置换治疗抗中性粒细胞胞质抗体（anti．neutrophilcytop｜asmieantibodies，ANCA）相关性血管炎（ANCAassociatedvasculitis，AAV）的疗效、不良反应。方法收集经病理确诊为AAV，且临床表现符合急进性肾小球肾炎综合征的患者资料共47例，其中25例予以甲泼尼龙冲击治疗（0．5gx3d），简称为普通组；余22例患者予以甲泼尼龙冲击联合血浆置换治疗，简称血浆组；比较2组患者治疗前、治疗后6个月的临床疗效及不良反应。结果（1）治疗后两组患者血清ANCA均较治疗前明显下降（P〈0．05），其中血浆组相对普通组下降更显著（P=0．028）。（2）治疗后两组Scr水平均较治疗前显著下降（P〈0．05），其中血浆组相对普通组下降更显著（P=0．043）。在BUN方面，治疗后血浆组相对于治疗前差异无统计学意义（P=0．175），而普通组相对于治疗前差异则有统计学意义（P=0．007），但两组间BUN的下降值差异无统计学意义（P=0．307）。（3）治疗后两组BVAS评分均显著下降（P〈0．05），但血浆组相对普通组下降更明显（P〈0．05）。（4）治疗后两组血清白蛋白、血红蛋白水平相对于治疗前差异均有统计学意义（P〈0．05），但两组治疗前后差值间差异均无统计学意义（P〉0．05）。（5）不良反应：血浆置换过程中及随访的6个月中，两组在感染及胃肠道并发症发生率等方面相当（P〉0．05）。结论单独激素冲击和联合血浆置换对AAV均有显著效果，联合血浆置换在肾功能改善以及ANCA清除上效果优于单独激素冲击治疗，安全性好。Objective To compare the clinical efficacy and side- effects of high dosage methylprednisolone combined with plasmapheresis or only with high dosage methylprednisolone treatment in patients with anti-neutrophil cytoplasmic antibodies （ANCA） associated vasculitis （AAV）. Methods Fortyseven patients with clinicopathologically diagnosed as ANCAassociated vasculitis kidney damage, whose clinical manifestations were also consistent with rapidly progressive glomerulonephritis syndrome, were treated with high dosage methylprednisolone and plasmapheresis （PE group, n=22） or only with high dosage methylprednisolone （MP group, n=25）. Patients received these two regimes were comparable in general conditions and clinicopathological parameters for the activity and severity of renal damage. Results At the 6 month, the serum level of ANCA were both lower significantly than before （P 〈 0.05）, and the PE group had the advantage to the MP group （P= 0.028）. The renal function was improved both in the two groups, and the serum creatinine of PE groupwas significantly lower than that in the MP group （P=0.043）, The BVAS scores were both significantly decreased in the two groups （P 〈 0.05）, and the scores were lower in the PE group than that in the MP group （P 〈 0.05）. Both the serum albumin and hemoglobin levels in the two groups were significantly increased after treatment （P 〈 0.05）, while the differences before and after treatment of the two levels between the two groups both had no significant difference （P 〉 0.05）. Three patients developed to end stage renal failure in each group during the follow-up period. The incidences of gastrointestinal symptoms （12.0% and 9.1% in MP and PE group, respectively） and infectious complications （28.0% and 22.7 % in MP and PE group, respectively） were similar between two groups. Conclusions Both the high dosage methylprednisolone combined with plasmapheresis treatment and the high dosage methylprednisolone treatment have significant effe

关 键 词：血浆去除术 甲泼尼龙 抗体 抗中性白细胞胞质 血管炎 

分 类 号：R543[医药卫生—心血管疾病]