血浆置换在抗中性粒细胞胞浆抗体相关小血管炎中的应用

The effect of plasma exchange in the treatment of anti-neutrophil cytoplasmic antibody-associated small-vessel vasculitis

抗中性粒细胞胞浆抗体(anti-neutrophil cytoplasmic antibodies,ANCA)相关小血管炎有相当高的病死率,存在肾损伤的患者发展为终末期肾病的风险较高。除糖皮质激素和免疫抑制剂之外,血浆置换也是治疗ANCA相关小血管炎的重要手段,其基本原理是快速清除患者血浆中的致病物质,以期改善疾病的预后。然而,既往研究对血浆置换治疗ANCA相关小血管炎患者的疗效存在意见分歧。本文通过检索相关文献,分析血浆置换在ANCA相关小血管炎治疗中的有效性和安全性,结果表明血浆置换可能有利于在短时间内降低重症患者的透析依赖率,而对肌酐水平的影响未能得出一致结论。既往前瞻性研究认为血浆置换不会明显改善患者的存活率,回顾性研究中血浆置换对血管炎患者存活率的影响存在争议。

Anti-neutrophil cytoplasmic antibody(ANCA)associated small-vessel vasculitis has a high mortality rate.Particularly,patients with renal injury diagnosed by ANCA associated small-vessel vasculitis(AAV)are at high risk of progresses to end-stage renal disease(ESRD).In addition to gluco⁃corticoids and immunosuppressants,plasma exchange is an essential treatment for ANCA-associated small-vessel vasculitis by removing of pathogenic substances in patients'plasma rapidly in order to im⁃prove the prognosis of the disease.However,it is still controversial of the use of plasma exchange for in⁃duction treatment of AAV.In this study,we analyzed the efficacy and safety of plasma exchange in the treatment of ANCA-associated small vasculitis.The results approved that plasma exchange might be ben⁃eficial to reduce dialysis dependence in severe patients in a short period of time.But previous researches failed to determine whether plasma exchange was able to reduce creatinine level.Most prospective stud⁃ies have suggested that plasma exchange was useless of improving patients’survival,while retrospective studies did not reach the agreement.