单膜血浆置换与双膜血浆置换治疗重症ANCA相关血管炎的对比研究  

Comparative study of single filtration plasma exchange and double filtration plasmapheresis in the treatment of severe ANCA-associated vasculitis

作　　者：汤月秋 苟慎菊[2] 卢晓梅 于洋[2] 朱丹 TANG Yue-qiu;GOU Shen-ju;LU Xiao-mei;YU Yang;ZHU Dan(Department of Endocrinology and Nephrology,363 Hospital;Department of Nephrology,West China Hospital,Sichuan University,Chengdu 610000,Sichuan,China)

机构地区：[1]三六三医院内分泌肾病内科 [2]四川大学华西医院肾内科,四川成都610000

出　　处：《川北医学院学报》2023年第7期901-905,共5页Journal of North Sichuan Medical College

基　　金：四川省科技计划项目(2021YFS0163)。

摘　　要：目的:探究单膜血浆置换(PE)与双膜血浆置换(DFPP)对于重症抗中性粒细胞胞浆抗体(ANCA)相关血管炎(AAV)的影响。方法:回顾性分析107例重症ANCA相关血管炎患者的临床资料,根据治疗方式不同将患者分为观察组(DFPP治疗,n=56)与对照组(PE治疗,n=51)。比较两组治疗前后ANCA血清学诊断结果、BVAS评分、肾功能指标[肌酐(SCr)、尿素氮(BUN)]、血流动力学指标[心率(HR)、平均动脉压(MAP)]及血液相关指标[C反应蛋白(CRP)、血红蛋白(Hb)、血清白蛋白(ALB)],记录并比较两组患者不良反应发生率。结果:治疗后,两组患者PR3-ANCA、MPO-ANCA滴度水平、BVAS评分、血清SCr、BUN水平均降低(P>0.05);两组患者CRP、Hb、ALB水平比较,差异无统计学意义(P>0.05)。两组患者置换前、置换30 min及置换2 h的HR、MAP值呈下降趋势,且观察组置换2 h的HR值及置换30 min的MAP值均高于对照组(P<0.05)。两组患者不良反应发生率比较,差异无统计学意义(P>0.05)。结论:PE与DFPP治疗AAV疗效相当,但后者血浆用量少,血流动力学的影响小。Objective:To study the effects of single filtration plasma exchange(PE)and double filtration plasmapheresis(DFPP)in the treatment of severe anti-neutrophil cytoplasmic antibody(ANCA)-associated vasculitis(AAV).Methods:The clinical data of 107 patients with severe ANCA related vasculitis were retrospectively analyzed,according to the treatment methods,the patients were divided into observation group(DFPP treatment,n=56)and control group(PE treatment,n=51).The ANCA serological diagnosis results,BVAS score,renal function indicators[serum creatinine(SCr),blood urea nitrogen(BUN)],hemodynamic indicators[heart rate(HR),mean arterial pressure(MAP)]and blood related indicators[C-reactive protein(CRP),heamoglobin(Hb),albumin(ALB)]were compared between the two groups before and after treatment,and the incidence rates of adverse reactions were recorded.Results:The titers of PR3-ANCA and MPO-ANCA,BVAS score and levels of serum SCr and BUN in the two groups after treatment were lower compared with those before treatment(P>0.05).There were no statistical differences between the two groups in terms of levels of CRP,Hb and ALB after treatment(P>0.05).The HR and MAP in the two groups before exchange and at 30 min and 2 h of exchange showed downward trends,and the HR value at 2 h of exchange and the MAP value at 30 min of exchange were higher in the observation group than those in the control group(P<0.05).The incidence rates of adverse reactions showed no statistical differences between the two groups(P>0.05).Conclusion:PE and DFPP have similar efficacy in the treatment of AAV,but the latter one has less plasma dosage and less influence on hemodynamics.

关 键 词：单膜血浆置换 双膜血浆置换 重症抗中性粒细胞胞浆抗体相关血管炎 伯明翰系统性血管炎活动评分 肾功能 

分 类 号：R457.1[医药卫生—治疗学]