血浆置换在新月体型肾小球肾炎中的临床疗效分析  

An Analysis of Plasma Exchange Therapy in Patients with Crescent Type Glomerulonephritis

作　　者：陈扬[1] 崔颖[1] 蒙军平[2] 李颖[1] 穆士杰[1] CHEN Yang;CUI Ying;MENG Jun-ping(Depar tment of Blood Transfusion,Tangdu Hospi tal of The Four th Mi l i tary Medical Universi ty,Xi＇an 710038)

机构地区：[1]陕西西安第四军医大学唐都医院输血科,710038 [2]陕西西安第四军医大学唐都医院肾内科,710038

出　　处：《临床输血与检验》2018年第5期505-507,共3页Journal of Clinical Transfusion and Laboratory Medicine

摘　　要：目的探讨血浆置换治疗新月体型肾小球肾炎的临床疗效。方法选择本院肾内科收治的经肾活检确诊的新月体型肾小球肾炎、急进性肾小球肾炎早期患者,入院后给予甲泼尼龙琥珀酸钠、环磷酰胺、硫唑嘌呤等抑制免疫炎症、抗凝、纠正贫血以及行血浆置换等治疗,行血浆置换治疗期间给予患者静推地塞米松磷酸钠注射液抗过敏,葡萄糖酸钙注射液预防低钙血症等治疗,每次置换血浆2 000 ml,调整血液流速为60 ml/min,间隔2 d/次,共3次。结果患者行3次血浆置换治疗后,复查抗GBM抗体(–),血常规:Hb 61g/L,肾功能:Cr 625μmol/L,BUN 25.2 mmol/L,UA 476μmol/L。结论新月体型肾小球肾炎、急进性肾小球肾炎患者早期给予大剂量糖皮质激素联合血浆置换治疗,可提高疾病治愈率,快速达到治疗效果。Objective To study the clinical therapeutic effect of plasma exchange on crescent type glomerulonephritis. Methods The cases of crescent type glomerulonephritis defined by renal biopsy were selected,including the early patients with rapidly progressive glomerular nephritis（RPGN）. The patients received the treatments of prednisolone sodium succinate,cyclophosphamide and azathioprine as immunosuppressive regimens. Simultaneously,anticoagulation, correction of anemia and plasma exchange treatments were administered. The patients were given dexamethasone and calcium gluconate to prevent allergy and hypocalcemia during the plasma exchange treatment with 2 000 ml of plasma and 60 ml/min on plasma transfusion for 3 times（once every the third day）. Results The patients presented negative GBM antibodies, 61 g/L of hemoglobin,625 μg/of Cr,25.2 mmol/L of BUN, and 476 μ mol of UA. Conclusions The therapeutic strategy of early plasma exchange, combined with sufficient glucocorticoids,may take effect rapidly and increase the curative rate in the patients with crescent type glomerulonephritis and RPGN.

关 键 词：血浆置换 急进性肾小球肾炎 临床疗效 

分 类 号：R457.1[医药卫生—治疗学] R692.31[医药卫生—临床医学]