中国血液净化

›› 2005, Vol. 4 ›› Issue (9): 472-475.

• 论著 • 上一篇    下一篇

蛋白A免疫吸附治疗急进性肾炎－附5例报告

滕 杰 陈利明 邹建洲 吉 俊 方 艺 丁小强 章晓燕 徐少伟 钟一红 傅辰生 袁 敏   

  1. 200032 上海，复旦大学附属中山医院肾内科
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2005-09-12 发布日期:2005-09-12
  • 通讯作者: 丁小强

  • Received:1900-01-01 Revised:1900-01-01 Online:2005-09-12 Published:2005-09-12

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目的 探讨蛋白A免疫吸附治疗急进性肾炎的临床疗效及对血清抗中性粒细胞胞浆抗体(ANCA) 或抗肾小球基膜抗体（抗-GBM）水平的影响。方法 复旦大学附属中山医院肾内科5例急进性肾小球肾炎患者,3例合并2型糖尿病,3例伴有两肺间质性炎症。肾活检示新月体比例为56.7%～5.9％,在糖皮质激素及环磷酰胺治疗的同时，运用葡萄球菌A蛋白吸附柱进行免疫吸附治疗。结果 单次免疫吸附治疗后，血清ANCA-MPO较治疗前明显下降[（54.34±31.73）vs（87.96±46.67）, P=0.003]；抗-GBM亦较治疗前下降，但差异无显著性[（13.00±11.61）vs（23.53±24.27）, P=0.079]。肾功能显著改善，2例治疗前需透析的患者中有1例无需维持透析，血肌酐由治疗前710μmol/L降至350μmol/L；3例治疗前无需透析的患者肾功能明显好转，由治疗前586μmol/L、197μmol/L、367μmol/L降至261μmol/L、136μmol/L、236μmol/L。肺部间质性炎症均有明显好转。免疫吸附治疗前后，患者肝功能、电解质、血糖、血常规、血压、心率、呼吸频率及血氧饱和度均保持稳定。5例患者全部存活。结论 葡萄球菌A蛋白吸附联合糖皮质激素及环磷酰胺冲击治疗，能快速、显著降低急进性肾炎患者循环中的ANCA、抗-GBM等自身抗体，改善肾功能和肺部病变，使患者迅速达到临床缓解，安全性好。

关键词: 蛋白A免疫吸附, 急进性肾小球肾炎

Abstract: Objectives To investigate the efficacy of Protein A immunoadsorption (IA) in the treatment of rapidly progressive glomerulonephritis and its influence the serum level of antineutrophil cytoplasmic antibody (ANCA) and anti-GBM antibody. Methods Five cases of rapidly progressive glomerulonephritis were involved whose renal biopsy showed that crescents was present in more than 50% of the glomeruli (56.7～5.9％). Of those cases, 3 accompanied with type 2 diabetes mellitus and 3 accompanied with interstitial pneumonia. All of the 5 patients had undertaken IA as well as the drug therapy with glucocorticoids and cyclophosphamides. Results Serum level of ANCA-MPO was reduced significantly after a single IA（54.34±31.73 vs 87.96±46.67, P=0.003）.There was also a reduction of serum anti-GBM antibody, but there was no statistic significance（13.00±11.61 vs 23.53±24.27,P=0.079）.Renal function were improved significantly in two cases who need dialysis therapy before IA. One of them didn't need dialysis support after IA therapy whose serum creatinine reduced from 710μmol/L to 350μmol/L. The other three cases also resulted in obvious amelioration of renal impairment after IA therapy, serum creatinine dropped from 586μmol/L、197μmol/L、367μmol/L to 261μmol/L、136μmol/L、236μmol/L respectively after several sessions of IA. Pulmonary interstitial lesions were improved in all cases. There were no changes in liver function, serum electrolytes, serum glucose, oxygen saturation or blood routine after IA therapy. Patients' vital signs such as blood pressure, heart rate and respiratory rate also kept steady during each session. All of the 5 patients survived. Conclusions Staphylococcus protein A immunoadsorption therapy combined with impulse therapy of glucocorticoids and cyclophosphamides significantly lowered the auto-antibodies like ANCA and anti-GBM antibody in the circulation of the patients with rapidl progressive glomerulonephritis. This combined therapy can resulted in improvement in renal function and rapid remission of the disease.

Key words: Rapidly progressive glomerulonephritis

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