摘要
目的:探讨葡萄球菌蛋白A免疫吸附(IA)联合霉酚酸酯(MMF)疗法对抗中性粒细胞胞浆抗体(ANCA)相关血管炎血清ANCA水平的影响及临床疗效。方法:6例ANCA相关血管炎伴活动性肾血管炎患者(男、女各3例,年龄19～60岁)临床均为微型多血管炎,ANCA均为MPO-ANCA,治疗前BVAS评分15～22分,均有肾功能不全[SCr(354.6±296.1)μmol/L,其中需即时透析1例],肾脏病理新月体比例(51.0±27.1)%。采用甲基泼尼松龙静脉冲击联合葡萄球菌蛋白A行IA治疗(IA隔日1次,每次吸附血浆4.5L,共3～10次)。IA结束后口服泼尼松及霉酚酸酯(1.5g/d)。观察IA过程中ANCA水平及病情变化,IA后MMF治疗过程中血管炎活动性(BVAS评分)、肾功能与尿检变化。结果:首次IA后1例血清ANCA转阴,其余5例ANCA下降37.2%～70.4%[平均(52.6±14.0)%]。3次IA后ANCA水平下降67.8%～91.5%[平均(81.8±10.0)%],吸附结束后ANCA下降至基础值(9.6±6.3)%,5例治疗前无需透析患者SCr均降至(206.9±106.1)μmol/L,其中1例降至正常,1例治疗前需透析患者治疗后摆脱透析(SCr由929.1μmol/L降至363.3μmol/L)。IA后MMF治疗随访3～12月,3例缓解,2例稳定,1例死亡。不良反应:IA治疗过程中1例发生低血压1次,随访中各有1例发生带状疱疹和口角疱疹,1例随访3月并发严重肺部感染死亡。结论:葡萄球菌蛋白A免疫吸附治疗能快速、有效降低血清ANCA水平,抑制血管炎活动性,改善肾功能,但IA后免疫抑制剂治疗过程中应注意预防感染。
Objective：To investigate the clinical efficacy of Protein A immunoadsorption （IA） and mycophenolate mofetil （MMF） in patients with ANCA-associated vasculitis （AAV） and their impact on the serum level of ANCA. Methodology：Six patients （3 male, 3 female, age 19 -60 years） with active AAV and renal vasculitis （BVAS 15 -22） , diagnosed as microscopic polyangitis, were enrolled in this study. Prior to the treatment, all patients showed positive MPOANCA, renal insufficiency （serum creatinine 354 ＋296 mmol/L） and crescent formation （51.0±27.1% ）. One of them was dialysis dependent. All patients received IA treatment （4. 5 L plasma treated per session, every other day） as well as methylprednisolone （MP） pulse therapy followed by oral prednisone and MMF. The changes of ANCA, BVAS and renal function were investigated. Results：After the first IA treatment, MPO-ANCA was eliminated in one patient. While the ANCA level of the other five patients was significantly lower, with the decrement of （52. 6 ±14. 0）% （37. 2% -70.4% ） after the first IA treatment and （81.8 ±10.0）% （67.8% -91.5% ） after three times of IA, respectively. After the course of IA treatment, the ANCA level was reduced to （9. 6 ±6. 3 ） % of the baseline. The renal function was improved in the patient who was dialysis-dependent （serum creatinine decreased from 929 to 363 μmol/L）. Serum creatinine level remained stable in 4 of other 5 patients, while one patient had renal function recovery. During follow-up （3 to 12 months）, three patients got remission and two remained stable. One patient died of respiratory failure caused by pulmonary infection after 3 months. The side effects： Hypotension occurred in one patient during IA treatment and improved after symptomatic treatment. During follow-up, two patients got mild virus infection and one died of severe pulmonary infection. Conclusion：Protein A immunoadsorption treatment could rapidly and effectively decrease serum ANCA level and improve renal function. Infectious complications should be prevented during follow-up immunosuppressive treatmant.
出处
《肾脏病与透析肾移植杂志》
CAS
CSCD
2007年第4期316-321,335,共7页
Chinese Journal of Nephrology,Dialysis & Transplantation
关键词
免疫吸附
葡萄球菌蛋白A
抗中性粒细胞胞浆抗体相关血管炎
immunoadsorption staphylococcal protein A anti-neutrophil cytoplasmic antibody associated vasculitis
