血浆置换联合激素冲击治疗对ANCA相关性血管炎肾损伤患者临床实验室指标水平的影响

Effect of plasma exchange combined with hormone pulse therapy on the levels of clinical laboratory indicators in patients with ANCA-associated vasculitis renal injury

目的探讨血浆置换联合激素冲击治疗对抗中性粒细胞胞质抗体(ANCA)相关性血管炎肾损伤患者临床实验室指标水平的影响。方法选取2019年9月至2021年10月在空军军医大学第二附属医院肾内科接受治疗并确诊为ANCA相关性血管炎肾损伤的患者共40例,按照随机数字表法分为研究组和对照组,每组各20例。研究组患者采用血浆置换联合激素冲击治疗。对照组患者采用激素冲击治疗。比较两组治疗前后的实验室指标水平,包括血清免疫球蛋白G(IgG)、清蛋白(ALB)、肾功能指标[血清肌酐(Scr)、尿素氮(BUN)、尿沉渣红细胞计数(URBC)、24 h尿蛋白定量]、炎症指标[降钙素原(PCT)、C反应蛋白(CRP)]、血常规[血红蛋白(Hb)、血小板计数(PLT)]、凝血指标[活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(Fib)]。结果两组治疗后IgG、Scr、BUN水平均较治疗前明显降低,差异有统计学意义(P<0.05)。研究组治疗后URBC水平较治疗前明显降低,差异有统计学意义(P<0.05)。研究组治疗前后ALB水平比较,差异无统计学意义(P>0.05);而对照组治疗后ALB水平较治疗前降低,差异有统计学意义(P<0.05)。对照组治疗后APTT水平较治疗前升高,差异有统计学意义(P<0.05);研究组治疗后Fib水平高于对照组,且研究组治疗后Fib水平低于治疗前,差异有统计学意义(P<0.05)。结论血浆置换联合激素冲击治疗ANCA相关性血管炎肾损伤安全、有效,可改善患者肾功能,值得在临床工作中进一步推广使用。

Objective To explore the effect of plasma exchange combined with hormone pulse therapy on the levels of clinical laboratory indicators in patients with antineutrophil cytoplasmic antibody(ANCA)-associated vasculitis renal injury.Methods A total of 40 patients with ANCA-associated vasculitis renal injury who were treated in the Department of Nephrology of Second Affiliated Hospital of Air Force Military Medical University from September 2019 to October 2021 were divided into the study group and the control group according to the random number table method,with 20 patients in each group.Patients in the study group were treated with plasma exchange and hormone pulse.Patients in the control group was treated with hormone pulse.The levels of laboratory indicators before and after treatment between the two groups were compared,included serum immunoglobulin G(IgG),albumin(ALB),renal function indicators[serum creatinine(Scr),urea nitrogen(BUN),urinary sediment red blood cell count(URBC),24-hour urine protein quantity],inflammatory indicators[procalcitonin(PCT),C-reactive protein(CRP)],blood routine test[hemoglobin(Hb),platelet count(PLT)],coagulation indicators[activated partial thromboplastin time(APTT),thrombin time(TT),fibrinogen(Fib)].Results The levels of IgG,Scr and BUN in the two groups after treatment were significantly lower than those before treatment,and the differences were statistically significant(P<0.05).The URBC level in the study group after treatment was significantly lower than that before treatment,the difference was statistically significant(P<0.05).There was no statistically significant difference on the level of ALB before and after treatment in the study group(P>0.05),while the level of ALB in the control group after treatment was significantly lower than that before treatment,the difference was statistically significant(P<0.05).The level of APTT in the control group after treatment was significantly higher than that before treatment,the difference was statistically significant(P<0.05).The Fib level in the study group after treatment was higher than that in the control group,and the Fib level in the study group after treatment was lower than that before treatment,the differences were statistically significant(P<0.05).Conclusion The treatment of ANCA-associated vasculitis renal injury with plasma exchange combined with hormone pulse is safe and effective,could improve the renal function of patients,and is worthy of further promotion in clinical work.