免疫吸附联合免疫抑制剂治疗ANCA相关性血管炎的疗效观察  

The clinical observation of the effect of immunoadsorbent combined with immunosuppressive therapy on ANCA associated vasculitis

作　　者：王浩宇[1] 刘园园[1] 彭小梅[1] 叶琨[1] 曾春[1] 贺红光[1] 熊礼佳[1] 唐盛[1] 

机构地区：[1]广西壮族自治区人民医院肾内科,南宁530021

出　　处：《中国临床新医学》2016年第11期981-984,共4页CHINESE JOURNAL OF NEW CLINICAL MEDICINE

基　　金：广西科学研究与技术开发项目(编号:桂科攻1598012-11)

摘　　要：目的探讨免疫吸附（IA）联合激素和环磷酰胺治疗抗中性粒细胞胞浆抗体（ANCA）相关性血管炎的近期疗效。方法选取2014-01-2016-01收治的ANCA相关性血管炎4例,每例患者使用HA280进行免疫吸附联合糖皮质激素加环磷酰胺治疗,观察治疗前后临床症状及ANCA水平的变化,比较血管炎活动性（BVAs评分）、尿蛋白定量、超敏C反应蛋白（hs-CRP）、血沉（ESR）、血肌酐（Scr）、白蛋白、免疫球蛋白的变化。结果治疗后全部患者关节痛、咯血、呼吸困难症状消失。HA280免疫吸附3次后,1例患者ANCA转阴,2例分别于治疗4个月、12个月后ANCA转阴,1例患者随访至3个月时仍为阳性。所有患者免疫吸附治疗后BVAs、hs-CRP、ESR均较治疗前明显下降（P〈0.05）。随访期间3例患者尿蛋白、Scr明显下降。IA治疗过程中1例发生低血压1次,1例出现一过性血小板下降1次,1例随访3个月因股动脉瘤破裂出血死亡。结论HA80免疫吸附联合激素和环磷酰胺治疗可有效快速降低ANCA水平,抑制血管炎活动性,降低蛋白尿,改善肾功能和临床症状。Objective To observe the clinical effect of immunoadsorption（ IA） combined with immunosuppressive therapy on ANCA associated vasculitis. Methods Four patients with ANCA-associated vasculitis were treated with HA280 immunoadsorben combined with hormones and cyclophosphamide. The changes of the levels of ANCA,BVAS,other biochemical indexes and clinical symtoms were compared before and after the treatment. Results All of the patients＇ clinical symptoms were improved after the treatment for 3 times,and ANCA turned negative in 1case after the IA treatment,and ANCA turned negative in 2 cases 4 and 12 months after the IA treatment. ANCA maintained posotive in 1 case after a follow-up of 3 monthes. BVAs,hs CRP and ESR were markedly reduced afrer the IA treatment（ P〈0. 05）. Urinary protein and serum creatinine declined in 3 cases during the follow-up. Hypotension occured in 1 case,and transient platelets declined in 1 case. One patient died of aneurysm rupture bleeding after a follow-up of 3 months. Conclusion DNA280 immunoadsorption combined with hormone and cyclophosphamide thera-py can effectively reduce the level of ANCA,inhibit the activity of vasculitis,reduce proteinuria,and improve the renal function and clinical symptoms in the patients with ANCA associated vasculitis.

关 键 词：免疫吸附 ANCA相关性血管炎 肾损害 

分 类 号：R55[医药卫生—血液循环系统疾病]