【摘要】 目的比较单纯激素冲击和激素冲击联合血浆置换治疗抗中性粒细胞胞质抗体(ANCA)相关性血管炎(AAV)的临床疗效。方法将63例病理诊断为AAV且临床表现符合急进性肾小球肾炎综合征的患者随机分为两组,对照组(n=31)单纯给予激素免疫抑制剂治疗,观察组(n=32)在对照组治疗方案基础上联合血浆置换治疗,比较两组患者的BVAS2003评分,ANCA、肌酐(SCr)、尿素氮(BUN)水平和感染并发症发生情况。结果两组患者的BVAS2003评分均较治疗前有明显降低(P<0.05),而观察组治疗的BVAS2003评分优于对照组(P<0.05);两组患者治疗6个月后的ANCA、SCr水平均较治疗前明显降低(P均<0.05),而观察组的ANCA、SCr的下降水平明显优于对照组(P<0.05);两组患者治疗前后的BUN无显著差异(P>0.05);两组患者的感染并发症情况无显著差异(P>0.05)。结论激素冲击联合血浆置换治疗AAV的疗效显著,较单纯激素冲击治疗有更优的ANCA清除和肾功能改善效果,且安全性较高。更多还原

【Abstract】 Objective To compare the efficacy of impact of hormone and impact of hormone combined plasma replacement in treatment of anti- neutrophil cytoplasmic antibodies( ANCA) related vasculitis( AAV). Methods A total of 63 cases pathologically diagnosed as AAV with clinical manifestations eligible to rapidly progressive glomerulonephritis syndrome were randomly divided into two groups: control group( n = 31)and obversation group( n = 32),patients in control group were given with hormone and immunosuppressant therapy,and patients in observation group were given with plasma replacement therapy on the basis of treatment in control group. BVAS2003 scores,levels of ANCA,creatinine( SCr)and urea nitrogen( BUN) and incidence of complications were compared between patients of these 2 groups. Results The rating of BVAS2003 in patients of these two groups were significantly lower than those before treatmennt( P < 0. 05),but BVAS2003 scores in observation group were better than those of control group( P < 0. 05). The ANCA level and serum level of creatinine( SCr) in both groups in 6 months after treatment were significantly lower than those before treatment( P < 0. 05),but the decrease in levels of ANCA and Cr in observation group was obviously better than those of control group( P < 0. 05). The difference in blood level of urea nitrogen( BUN) between patients of these 2 groups before and after treatment was not significant( P > 0. 05). The difference in incidence of complicated infections in patients between these 2 groups was not significant( P > 0. 05). Conclusion The efficacy of treatment with impact of hormone combined plasma replacement in treatment of patients with AAV is significantly better than that of simple hormonal impact,and it has better effect in removal of ANCA and it can improve the renal function with high safety.更多还原