双重血浆置换治疗狼疮性肾炎伴血栓性微血管病疗效分析  

Clinical efficiency of double filtration plasmapheresis in lupus nephritis with renal thrombotic microangiopathy

作　　者：王悦至 梁少姗[1] 龚德华[1] 刘正钊[1] 章海涛[1] 曾彩虹[1] 刘志红[1] 胡伟新[1] 

机构地区：[1]南京大学医学院附属金陵医院(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 [2]南京大学医学院

出　　处：《中国实用内科杂志》2015年第6期506-511,共6页Chinese Journal of Practical Internal Medicine

基　　金：国家自然科学基金(81470042);江苏省自然科学基金(BK20131326);国家科技支撑计划课题(2011BAI10B04)

摘　　要：目的探讨双重血浆置换(DFPP)治疗狼疮性肾炎伴血栓性微血管病(LN-TMA)的临床疗效。方法以2010年1月至2013年6月南京军区南京总医院经肾活检确诊为LN-TMA且行DFPP治疗的21例患者为研究对象,所有患者采用免疫抑制方案联合DFPP治疗(DFPP组),以同期仅采用免疫抑制方案治疗的30例LN-TMA作为对照。比较两组患者3个月时摆脱肾脏替代治疗和血肌酐(Scr)下降50%比例、血清自身抗体水平及2年人肾存活率。结果 DFPP组21例中5例治疗2次,16例治疗3次。3个月时DFPP组13例需肾脏替代治疗的患者中11例(84.6%)摆脱了透析,对照组16例中8例(50%)摆脱透析(P=0.051),治疗初无需肾脏替代治疗的患者Scr下降50%的比例DFPP组高于对照组(62.5%对35.7%,P>0.05),DFPP组抗磷脂抗体转阴率明显高于对照组(55.6%对8.3%,P<0.05),但抗ds DNA抗体转阴率及补体水平变化两组间差异无统计学意义。随访期间两组均无死亡病例,分别有3例(14.3%)和8例(26.6%)进入终末期肾病,DFPP组和对照组2年肾存活率分别为90.5%和73.3%,差异无统计学意义(P>0.05)。治疗初需肾脏替代治疗患者的2年肾存活率DFPP组(84.6%)显著高于对照组(50%)(P=0.044)。结论免疫抑制治疗联合DFPP能增加近期摆脱肾脏替代治疗患者的比例,显著改善有严重肾功能损伤患者的远期肾脏存活率。Objective To investigate the clinical efficacy of double filtration plasmapheresis （DFPP） in treatment of patients with lupus nephritis and thrombotic microangiopathy （LN-TMA）. Method Twenty one patients with biopsy-proven LN-TMA treated with DFPP and immunosuppressions （DFPP group） and 30 patients with biopsy-proven LN-TMA treated with immunosuppressions only （control group） were observed. The ratio of patients free from dialysis, with serum creatinine decrease over 50%, the levels of serum autoantibodies at 3 months and the renal survival rates at 2 years were compared between the DFPP group and the control group retrospectively. Results In the DFPP group, 5 patients were treated with DFPP twice and 16 patients were treated 3 times. At 3 months, 84.6% of patients with renal replacement therapy at baseline in the DFPP group were free from dialysis, while in the control group, the rate was 50% （P= 0.051）. In the DFPP group, 62.5% of patients free of dialysis at baseline were found with serum creatinine decrease over 50%, higher than that in the control group （35.7%, P 〉0.05）. The negative rate of antiphospholipid antibody was 55.6% in the DFPP group, significantly higher than that in the control group （8.3%, P〈 0.05）. There were no siginificant differences in the changes of antbdsDNA titers and serum complement levels between the two groups. No patients died both groups. Three （14.3%） patients developed end-stage renal disease （ESRD） in the DFPP group and 8 （26.6%） did in control group. The 2-year renal survival rate was 90.5% in the DFPP group, higher than that in the control group （73.3%, P 〉 0.05）. Among patients with renal replacement therapy at baseline, the 2-year renal survival rates of patients in the DFPP group were significantly higher than that in the control group （84.6% vs. 50%, P= 0.044）. Conclusion DFPP accompanied with immunosuppressive therapy could significantly improve the renal survival rates in patients with severe renal deficiency.

关 键 词：双重血浆置换 狼疮性肾炎 血栓性微血管病 

分 类 号：R593.242[医药卫生—内科学]