激素联合环磷酰胺双治疗对原发ANCA相关性小血管炎肾损害的保护肾脏作用分析

Analysis of Renal Protection Effects of Hormone Combined with Cyclophosphamide Double Therapy on Renal Damage in Primary ANCA Associated Small Vasculitis

目的:研究并探讨激素联合环磷酰胺双治疗对原发抗中性粒细胞胞浆抗体(Anti-Neutrophil Cytoplasmic Antibodies,ANCA)相关性小血管炎肾损害的保护肾脏作用。方法:入组对象选择本院在2013年1月-2017年12月期间收治的原发ANCA相关性小血管炎肾损害患者100例,按照随机数字表法将患者分为对照组和观察组,每组各50例。对照组采用单纯激素治疗,观察组采用激素联合环磷酰胺治疗,比较两组患者的临床疗效、伯明翰血管炎活动评分(Birmingham vasculitis activity score,BVAS)、尿素氮(BUN)、血肌酐(Scr)、慢性肾功能衰竭发生率、不良反应发生情况。结果:观察组总有效率为96%,高于对照组82%,比较差异有统计学意义(字2=5.005,P=0.025)。治疗前,组间BVAS评分、BUN、Scr比较,差异均无统计学意义(P>0.05);治疗后,两组患者的BVAS评分明显低于治疗前,且观察组的BVAS评分低于对照组,比较差异均有统计学意义(P<0.05)。观察组的BUN、Scr均优于对照组,比较差异均有统计学意义(P<0.05)。观察组的慢性肾功能衰竭发生率为4%,对照组为6%,比较差异无统计学意义(χ~2=0.211,P=0.646)。观察组的不良反应总发生率为6%,对照组为2%,比较差异无统计学意义(P>0.05)。结论:在原发ANCA相关性小血管炎肾损害患者中采用激素联合环磷酰胺治疗,可有效发挥肾脏保护作用,使患者肾功能得到改善,且药物副作用较少,安全性可靠。

Objective：To study and explore the renal protection effects of hormone combined with cyclophosphamide double therapy on renal damage of primary anti-neutrophil cytoplasmic antibodies（ANCA） associated small vasculitis.Method：A total of 100 patients with primary ANCA associated vasculitis and renal damage in our hospital from January 2013 to December 2017 were selected,in the computer according to the random number table method,they were divided into control group and observation group,50 cases in each group.The control group was treated with simple hormone therapy,observation group were treated with hormone combined with cyclophosphamide therapy,clinical efficacy,Birmingham vasculitis activity score（BVAS）,blood urea nitrogen（BUN）,serum creatinine（Scr）,the incidence of chronic renal failure,adverse reactions of the two group patients were compared.Result：The total effective rate of the observation group was 96%,which was higher than 82% of the control group,the difference was statistically significant（χ~2=5.005,P=0.025）.Before treatment,there was no significant difference in BVAS score,BUN,Scr between the two groups（P〉0.05）;after treatment,the BVAS scores of the two groups were significantly lower than those before treatment,and the BVAS score of the observation group was lower than that of the control group,the difference was statistically significant（P〈0.05）.BUN,Scr in the observation group were better than those in the control group,the difference were statistically significant.The incidence of chronic renal failure in observation group was 4% and 6% in the control group,there was no significant difference between the two groups（χ~2=0.211,P=0.646）.The total incidence of adverse reactions was 6% in the observation group and 2% in the control group,there was no significant difference between the two groups（P〉0.05）.Conclusion：In primary ANCA associated small vasculitis patients with renal damage,the use of hormone combined with cyclophosphamide therapy can play an effective role in renal protection,improve the renal function of patients,and less side effects of drugs,safe and reliable.