多靶点疗法治疗抗中性粒细胞细胞质抗体相关性血管炎肾损害的初步临床观察  

Preliminary clinical observation of multi-target therapy for the treatment of ANCA-associated vasculitis with renal involvement

作　　者：李康[1] 章海涛[1] 杨柳[1] 程震[1] 刘正钊[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,南京医学博士210002

出　　处：《医学研究生学报》2015年第9期934-939,共6页Journal of Medical Postgraduates

基　　金：国家科技支撑计划课题(2011BAI10B04);江苏省省级科技创新与成果转化(生命健康科技)专项资金(BL2012007);南京军区医药卫生科研基金(12Z29)

摘　　要：目的 针对抗中性粒细胞细胞质抗体（anti-neutrophil cytoplasmic antibodies,ANCA）相关性血管炎（ANCA associated vasculitis,AAV）的治疗方案如激素联合环磷酰胺或吗替麦考酚酯（mycophenolate mofetil,MMF）虽可提高治疗缓解率,但复发率及治疗相关的不良反应发生率高。文中回顾性观察多靶点疗法治疗AAV肾损害患者的临床疗效与安全性。方法回顾性收集2009年6月至2013年10月间在南京军区南京总医院诊断为AAV,伴有肾损害,血肌酐（serum creatinine,SCr）≤3 mg/d L,并采用多靶点疗法治疗的患者7例,其中男性1例、女性6例,年龄21-54岁,均为髓过氧化物酶-ANCA（myeloperoxidase-ANCA,MPO-ANCA）阳性,均有大量尿蛋白和血尿。其中4例SCr升高（1.47-2.94 mg/d L）伴e GFR90 m L/min、1例e GFR60 m L/min的3例e GFR均恢复正常。随访末,4例e GFR正常,1例e GFR介于60-90 m L/min之间,2例e GFR＆lt;60 m L/min,无终末期肾病发生。3例血清MPO-ANCA转阴,4例MPO-ANCA水平明显下降。随访期间无严重不良反应,无复发及死亡。结论 多靶点疗法可有效控制伴轻中度肾功能损害AAV患者的肾活动,显著改善肾功能和尿蛋白,耐受性良好,但其疗效仍需临床研究进一步验证。Objective The treatment of anti-neutrophil cytoplasmic antibodies （ANCA） associated vasculitis （AVV） such as myeophenolate mofetil （MMF） can improve the remission rate, however, it also results in high recurrence rate and high incidence of adverse reaction related to the treatment. The article was to observe the clinical efficacy and safety of multi-target therapy （MT） in the treatment of AAV with renal involvement. Methods Retrospective observation was made on 7 AVV patients treated with multi-target therapy in our department from June 2009 to October 2013. The patients （1 male, 6 females） aged from 21 to 54 years were accompariled with renal damage and serum creatinine （ SCr ≤3 mg/dL）. All patients had positive myelopeeroxidase-ANCA （MPO-ANCA）, high-grade proteinuria and hematuria. 4 patients had elevated SCr （1.47 -2.94 mg/dL） with EGFR 〈 60 mL/min, 3 patients had normal SCr （EGFR 〉 90 mL/min in 2 patients and EGFR 〈 90mL/min in 1 patient）. The renal histological classification included focal type （ n = 5 ） and crescentic type （ n = 2）. All patients received MT therapy which was composed with the steroids, MMF （0.5 - 0.75 g/d） and FK506 （1.5-3 mg/d）. The remission rate, the change of renal function, proteinuria and ANCA, adverse reaction and relapse were investigated. Results The patients had received MT for 6 to 24 months （median 12 m） and had been followed up for 9 to 53 months （ median 46 m ）. All patients achieved remission during MT induction treatment. The Birmingham vasculitis activity score （BVAS） decreased from 14 （6 - 16） to 0, without urinary sediment, and complete remission of proteinuria was found in 6 patients. Before the therapy the EGFR expression was normal in 1 patient and 64.8 -87.4 mL/min in 3 patients among 4 patients （EGFR 〈 60 ml/min） , and the EGFR expression became normal in 3 patients （EGFR 〉 60 ml/min）. At the end of follow-up, the EGFR expression was normal in 4 patients, 60 - 90 ml-/min in 1 pat

关 键 词：多靶点疗法 ANCA 血管炎 疗效 安全性 

分 类 号：R543[医药卫生—心血管疾病]