中国血液净化

中国血液净化 ›› 2020, Vol. 19 ›› Issue (09): 618-622.doi: 10.3969/j.issn.1671-4091.2020.09.011

• 临床研究 • 上一篇    下一篇

双膜血浆置换对需肾替代治疗的抗中性粒细胞胞浆抗体相关性血管炎的疗效及预后研究

钟卿1,黄显莉1,郝炎1,蔡康琴1   

  1. 1自贡市第一人民医院肾内科
  • 收稿日期:2020-04-28 修回日期:2020-07-07 出版日期:2020-09-12 发布日期:2020-09-03
  • 通讯作者: 钟卿 zhongqing851105@163.com E-mail:zhongqing851105@163.com
  • 基金资助:
    四川省医学科研课题计划(S18070)

Efficacy and prognosis of double-filtration plasmapheresis therapy for anti-neutrophil cytoplasm antibody-associated vasculitis which requires renal replacement therapy

  1.  1Department of Nephrology, the First People’s Hospital of Zigong, Sichuan 643000, China
  • Received:2020-04-28 Revised:2020-07-07 Online:2020-09-12 Published:2020-09-03

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摘要： 【摘要】目的探讨双膜血浆置换对需肾替代治疗的抗中性粒细胞胞浆抗体相关性血管炎的疗效及对生存率的影响。方法纳入2015 年1月～2017 年3月在自贡市第一人民医院确诊为抗中性粒细胞胞浆抗体(anti-neutrophil cytoplasm antibody, ANCA)相关性血管炎的患者25例，确诊时即需要肾替代治疗，随机分为接受激素联合环磷酰胺免疫抑制治疗+双膜血浆置换(double-filtration plasmapheresis, DFPP)治疗的DFPP 组(12 例)和只接受激素联合环磷酰胺免疫抑制治疗的对照组(13 例)，分析入组时患者一般情况，测定2 组患者治疗前后的ANCA、IgG 水平，记录随访12 个月患者的存活情况。结果DFPP组治疗后髓过氧化物酶抗体(myeloperoxidase-ANCA,MPO-ANCA)及IgG 水平较治疗前明显下降,下降率分别为53.2%(t=12.131，P＜0.001),47.4%(t=10.798,P＜0.001)。对照组治疗后MPO-ANCA 水平较治疗前下降16.7%(t=10.319，P=0.069)，对照组治疗后IgG 水平较治疗前下降14.1%(t=10.134，P=0.035)。DFPP 组治疗后IgG 水平与对照组治疗后相比下降33.8%，差异有统计学意义(t=5.334，P=0.012)。随访12 个月，累计存活率DFPP 组为61.5%，对照组为58.3%(c2=0.193，P=0.046)，2 组中存活患者均未摆脱透析。结论双膜血浆置换能有效降低患者IgG 及MPO-ANCA 抗体水平，提高患者1 年存活率，但不能有效提高患者的摆脱透析率。

关键词: 双膜血浆置换, 肾脏替代治疗, 抗中性粒细胞胞浆抗体, 预后

Abstract: 【Abstract】Objective The objective of this study was to investigate the effect of double-filtration plasmapheresis (DFPP) therapy on anti- neutrophil cytoplasmic antibody (ANCA)- associated vasculitis that requires renal replacement therapy (RRT) and its effect on survival rate. Methods A total of 25 patients with ANCA-associated vasculitis diagnosed in the First People's Hospital of Zigong from January 2015 to March 2017 were enrolled in this study. RRT was required at the time of diagnosis. Patients were randomly divided into the DFPP group (n=12) and the control group (n=13). Both groups received glucocorticoid and cyclophosphamide
immunosuppressive therapy; the DFPP group also treated with DFPP therapy. Demographic data and clinical parameters of the patients were collected. ANCA and IgG levels were measured before and after DFPP therapy for three times. Their survival rate was calculated after follow-up for 12 months. Results In the DFPP group, myeloperoxidase (MPO)- ANCA and IgG levels after the treatment decreased by 53.2% (t=12.131, P＜0.001) and 47.4% (t=10.798, P＜0.001) respectively. In the control group, MPO-ANCA level after the treatment decreased 16.7% (t=10.319, P=0.069), and IgG level decreased by 14.1% (t=10.134, P=0.035). In the DFPP group, IgG level decreased by 33.8% as compared with that in the control group (t=5.334, P=0.012). During the follow-up period of 12 months, the cumulative survival rate was 61.5% in the DFPP group and 58.3% in the control group (c2= 0.193, P=0.046). All survival patients still relied on dialysis during the follow-up study. Conclusion DFPP can effectively reduce the levels of IgG and MPO-ANCA and improve one year survival rate. However, DFPP cannot change dialysis dependence of the patients.

Key words: double-filtration plasmapheresis therapy, Renal replacement therapy, Anti-neutrophil granulocyte cytoplasmic antibody, Prognosis

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