论文部分内容阅读
目的探讨糖皮质激素联合环磷酰胺(CTX)方案治疗抗中性粒细胞胞质抗体(ANCA)相关小血管炎(AAV)的临床疗效。方法选取四川大学华西医院肾脏内科2012年8月—2014年8月收治的AAV患者64例,依据ANCA类型将分为MPO-ANCA AAV为A组22例、PR3-ANCA AAV为B组21例及ANCA阴性AAV为C组21例,患者均行糖皮质激素联合CTX治疗方案治疗6个月。分析患者的临床病理特征,并比较3组患者治疗前后伯明翰血管炎活动性评分量表(BVAS)评分、血肌酐及ANCA相关抗体滴度。结果 64例患者病理表现丰富,多为新月体肾炎,少数患者表现为局灶节段硬化性肾小球肾炎、间质性肾炎,可伴有系膜增生及小动脉病变。治疗前后3组患者BVAS评分、血肌酐及ANCA相关抗体滴度比较,差异有统计学意义(P<0.05);治疗后3组患者BVAS评分、血肌酐及ANCA相关抗体滴度低于治疗前,差异有统计学意义(P<0.05)。结论糖皮质激素联合CTX治疗AAV的临床疗效确切,肾脏病理有助于治疗方案的选择,而早期诊断治疗可明显改善患者预后。
Objective To investigate the clinical efficacy of glucocorticoid combined with cyclophosphamide (CTX) in the treatment of anti-neutrophil cytoplasmic antibody (ANCA) -related vasculitis (AAV). Methods Sixty-four patients with AAV admitted to Huaxi Hospital of Sichuan University from August 2012 to August 2014 were selected and divided into MPO-ANCA AAV group A (22 cases), PR3-ANCA AAV group B (21 cases) ANCA-negative AAV C group of 21 patients, patients were treated with corticosteroids and CTX treatment for 6 months. The clinicopathological characteristics of the patients were analyzed. The BVAS scores, serum creatinine and ANCA-related antibody titers were compared between the three groups before and after treatment. Results 64 cases of pathological manifestations of rich, mostly crescentic nephritis, a small number of patients showed focal segmental sclerosing glomerulonephritis, interstitial nephritis, may be associated with mesangial proliferation and arteriolar lesions. The BVAS score, serum creatinine and ANCA-related antibody titers in three groups before and after treatment were significantly different (P <0.05). The BVAS score, serum creatinine and ANCA-related antibody titers in three groups were lower than those before treatment, The difference was statistically significant (P <0.05). Conclusion The clinical efficacy of glucocorticoids combined with CTX in the treatment of AAV is definite. The renal pathology contributes to the choice of treatment options. Early diagnosis and treatment can significantly improve the prognosis of patients.