摘要
目的分析血浆置换对需肾替代治疗的血栓性微血管病(TMA)及抗中性粒细胞胞浆抗体(ANCA)诱导的相关性血管炎的有效性和安全性。方法采用回顾性研究方法,收集并分析安徽医科大学第一附属医院北区血液净化中心2021年6月至2022年2月行血浆置换治疗的患者4例的临床资料,共行19例次治疗,其中运用单重血浆置换方案3例、15例次,采用双重滤过血浆置换(DFPP)方案1例、4例次,记录治疗前后病情变化及相应的生化检查结果。结果4例患者的临床症状及生化检查指标均改善,3例进入维持性血液透析阶段,1例治疗效果显著。治疗后血红蛋白水平由76 g/L升高至83 g/L,血肌酐由703.6μmol/L下降至526.2μmol/L,抗Sm抗体由>400 RU/mL下降至<2 RU/mL,抗髓过氧化物酶(MPO)抗体由255.49 RU/mL下降至15.64 RU/mL,环核型抗中性粒细胞抗体(pANCA)转阴。其中2例治疗过程中出现过敏反应,抗过敏对症处理后症状明显缓解。结论血浆置换对需肾替代治疗的TMA及ANCA相关血管炎(AAV)的治疗安全有效。
Objective To investigate the effectiveness and safety of plasma exchange for thrombotic microangiopathy and anti-neutrophil cytoplasmic antibody(ANCA)-associated vasculitis,which require renal replacement therapy.Methods This is a retrospective study.The clinical data of four patients who underwent plasma exchange at the Blood Purification Center,North Branch of the First Affiliated Hospital of Anhui Medical University,from June 2021 to February 2022 were collected and analyzed.The records included a total of 19 treatments performed,including 15 treatments with a single plasma exchange regimen used in 3 patients and 4 treatments with double filtration plasmapheresis used in 1 patient.Changes in condition before and after treatment,as well as corresponding biochemical test results,were recorded.Results In four patients,clinical symptoms and biochemical indicators improved.Three patients required maintenance hemodialysis,while one patient showed remarkable clinical efficacy.After treatment,hemoglobin level increased from 76 g/L to 83 g/L,blood creatinine level decreased from 703.6μmol/L to 526.2μmol/L,anti-SM antibody decreased from>400 RU/mL to<2 RU/mL,anti-myeloperoxidase antibody decreased from 255.49 RU/mL to 15.64 RU/mL,and perinuclear anti-neutrophil cytoplasmic antibody turned negative.During treatment,there were two cases of allergic reactions,which were significantly alleviated after treatment.Conclusion Plasma exchange is safe and effective against thrombotic microangiopathy and anti-neutrophil cytoplasmic antibody-associated vasculitis,which require renal replacement therapy.
作者
靳艳艳
张璟
Jin Yanyan;Zhang Jing(Department of Renal Rheumatism,First Affiliated Hospital of Anhui Medical University,Anhui Public Health Clinical Center,Hefei 230012,Anhui Province,China)
出处
《中国基层医药》
CAS
2024年第2期235-238,共4页
Chinese Journal of Primary Medicine and Pharmacy
关键词
血浆置换
自身免疫疾病
急性肾损伤
血栓性微血管病
抗中性粒细胞胞浆抗体相关性血管炎
Plasma exchange
Autoimmune diseases
Acute kidney injury
Thrombotic microangiopathies
Anti-neutrophil cytoplasmic antibody-associated vasculitis
作者简介
通信作者:张璟,Email:13966602169@163.com。
