双重血浆置换对ANCA相关性血管炎肾损害患者肾功能和BVAS评分的影响

Effect of double plasma exchange on renal function and BVAS score in patients with ANCA associated vasculitis with renal damage

目的:探讨双重血浆置换对抗中性粒细胞胞质抗体(anti-neutrophil cytoplasmic autoantibody,ANCA)相关性血管炎(ANCA-associated vasculitis,AAV)肾损害患者肾功能及伯明翰血管炎性活动性(Birmingham Vasculitis Activity Score,BVAS)评分的影响。方法:回顾性分析海口市第三人民医院肾内科确诊收治102例AAV肾损害患者的临床资料,其中44例接受糖皮质激素(glucocorticoid,GC)联合环磷酰胺(cyclophosphamide,CTX)的AAV标准方案治疗,为CTX组;另58例在CTX方案同时给予血浆置换治疗,为观察组。比较分析两组血清ANCA水平、肌酐(serum creatinine,Scr)、尿素氮(blood urea nitrogen,BUN)、白蛋白(albumin,ALB)、BVAS评分及不良反应等指标。结果:两组治疗后蛋白酶3(protease 3,PR3)-ANCA(PR3-ANCA)、髓过氧化物酶(myeloperoxidase,MPO)-ANCA(MPO-ANCA)滴度、Scr、BUN、BVAS评分均明显下降(P<0.05),观察组治疗后PR3-ANCA、MPO-ANCA滴度水平、Scr和BVAS评分均低于CTX组(P<0.05),两组治疗前后ALB水平比较,差异无统计学意义(P>0.05);两组肺部感染、胃肠道反应及不良反应总发生率比较,差异无统计学意义(P>0.05)。结论:血浆置换能有效降低AAV肾损害患者ANCA滴度,改善肾功能和降低BVAS评分,且不降低ALB水平和增加不良反应,安全性好。

Objective:To investigate the effect of dual plasma exchange on renal function and Birmingham Vasculitis Activity Score(BVAS)in patients with renal damage caused by anti-neutrophil cytoplasmic autoantibody(ANCA)associated vasculitis(AAV).Methods:The clinical data of 102 patients with AAV renal damage in Department of Nephrology,Haikou Third People’s Hospital were retrospectively analyzed.Among them,44 patients were treated with glucocorticoid(GC)combined with cyclophosphamide(CTX)AAV standard regimen,which served as a CTX group;the other 58 patients were treated with CTX regimen and plasma exchange,which served as an observation group.Serum ANCA level,serum creatinine(Scr),blood urea nitrogen(BUN),albumin(ALB),BVAS score,and adverse reactions were compared between the two groups.Results:After treatment,the titers of PR3-ANCA,MPO-ANCA,Scr,BUN,and BVAS in the two groups were significantly decreased(P<0.05).The titers of PR3-ANCA,MPO-ANCA,Scr,and BVAS in the observation group were lower than those in the CTX group(P<0.05),and there was no significant difference in ALB level between the two groups before and after treatment(P>0.05).There was no significant difference in the total incidence of pulmonary infection,gastrointestinal reactions,and adverse reactions between the two groups(P>0.05).Conclusion:Plasma exchange can effectively reduce ANCA titer,improve renal function and reduce BVAS score in patients with AAV renal damage,without reducing ALB level and increasing adverse reactions,and the safety is good.