激素冲击和联合血浆置换治疗重症ANCA相关性血管炎的疗效比较

发布时间：2018-08-30 20:12

【摘要】：目的回顾性对照研究单独大剂量激素冲击疗法和激素冲击联合血浆置换治疗重症ANCA相关性血管炎的疗效及其副作用。方法回顾性收集在我科住院并经临床病理确诊为重症ANCA相关性血管炎,并且其临床表现符合急进性肾小球肾炎的患者资料总共有47例,其中的25例单独给予大剂量甲泼尼松冲击治疗(0.5g*3d),简称为普通组;其余的22例患者在此基础上给予联合使用血浆置换治疗,简称血浆置换组;回顾性比较分析2组患者治疗前、治疗后6个月的临床疗效与血清ANCA水平的变化及副作用。结果①在ANCA的清除方面,两组与治疗前相比较,均有显著性差异(血浆置换组188.8±47.7vs48.5±62.7,P=0.000;普通组175.8±77.6vs81.8±64.7,P=0.000),与普通组相比,血浆置换组在ANCA的清除方面更具优势(140.3±60.7vs94.0±76.6,P=0.028)。②肾功能方面:两组血肌酐水平较治疗前均有显著下降,差异有统计学意义(血浆置换组555.38±116.7vs280.5±178.1,P=0.000;普通组500.9±127.7vs 322.1±184.4,P=0.000),血浆置换组血肌酐的改善较普通组更显著(273.3±144.3vs178.8±164.0,P=0.043);在血尿素氮的比较上,血浆置换组较前无显著性差异(P=0.175),而普通组较前则有显著性差异(P=0.007),但两组间BUN的下降值无显著性差异(P=0.307)。③BVAS评分:治疗后两组在BVAS评分均较前显著下降(血浆组13.8±1.9vs2.1±0.9,P=0.000;普通组14.1±2.0vs4.9±1.2,P=0.000),但血浆置换组较普通组下降更多(P0.05)。④其他理化指标的改变:两组患者血清白蛋白、血红蛋白较治疗前有显著差异(P0.05),但两组间的下降值无显著性差异(P0.05)。⑤不良反应:在血浆置换过程中,均未出现明显不良反应。在随访的6个月中,两组患者均以感染及胃肠道并发症最常见,两组间无显著性差异(P0.05)。结论单独大剂量激素冲击和激素冲击联合血浆置换对于重症ANCA相关性血管炎均有显著效果,激素冲击联合血浆置换在肾功能改善以及ANCA清除方面效果优于单独激素冲击治疗,安全性好。
[Abstract]:Objective to retrospectively study the efficacy and side effects of high dose hormone shock therapy and hormone shock combined with plasma exchange in the treatment of severe ANCA associated vasculitis. Methods A total of 47 patients with severe ANCA associated vasculitis who were hospitalized in our department and whose clinical manifestations were consistent with advanced glomerulonephritis were retrospectively collected. Twenty-five of them were treated with high-dose methylprednisone pulse therapy (0.5g*3d) alone, and the remaining 22 patients were treated with combined plasma exchange therapy, or plasmapheresis group. Changes of clinical efficacy, serum ANCA level and side effects at 6 months after treatment. Results 1 there was significant difference between the two groups in the clearance of ANCA (188.8 卤47.7vs48.5 卤62.7 P0. 000 in plasma exchange group and 175.8 卤77.6vs81.8 卤64.7 P0. 000 in normal group). In plasma exchange group, the clearance of ANCA was superior (140.3 卤60.7vs94.0 卤76.6P0. 028). 2 Renal function: the serum creatinine level in both groups was significantly lower than that before treatment. The difference was statistically significant (555.38 卤116.7vs280.5 卤178.1P0. 000 in plasma exchange group and 500.9 卤127.7vs 322.1 卤184.4 P0. 000 in normal group), and the improvement of serum creatinine in plasma exchange group was more significant than that in normal group (273.3 卤144.3vs178.8 卤164.0 P0. 043). There was no significant difference in BUN between the two groups (P0. 175) and normal group (P0. 007), but there was no significant difference between the two groups (P0. 307). 3BVAS scores: after treatment, the BVAS scores of the two groups were significantly lower than those of the former (13. 8 卤0. 9 1.9vs2.1 卤0. 000). The changes of other physical and chemical indexes in the plasma exchange group were significantly lower than that in the normal group (P 0.05). The changes of serum albumin in the two groups were as follows: 1 卤1. 1 卤1. 2 2.0vs4.9 卤1. 2 + P0. 000). There was significant difference in hemoglobin between the two groups (P0.05), but there was no significant difference between the two groups (P0.05). 5 adverse reactions: in the process of plasma exchange, there were no significant adverse reactions. During the 6 months follow-up, infection and gastrointestinal complications were the most common in the two groups, and there was no significant difference between the two groups (P0.05). Conclusion both high dose hormone shock and hormone shock combined with plasma exchange have significant effects on severe ANCA associated vasculitis. The effects of hormone shock combined with plasma exchange on renal function improvement and ANCA clearance are superior to those of hormone shock alone. Good safety.
【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R593.2

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