血浆置换对抗中性粒细胞胞质抗体相关性血管炎患者外周血高迁移率族蛋白-1水平的影响

目的：观察血浆置换对抗中性粒细胞胞质抗体相关性血管炎（ANCA-associated vasculitis,AAV）外周血高迁移率族蛋白-1（highmobility group box chromosomal protein 1,HMGB1）的影响。方法：13例活动期AAV患者,男10例,女3例,年龄41岁~76岁,BVAS评分（21.8±4.9）分,其中11例p/MPO-ANCA阳性,2例c/PR3-ANCA阳性,ANCA水平（295.78±52.76）RU/m L。均给予糖皮质激素及其冲击疗法等治疗基础上,辅以血浆置换。分别留取血浆置换治疗前空腹（TO）、治疗开始后2 h（T1）、血浆置换停止后12 h（T2）患者静脉血标本,分离血清后采用ELISA法检测其中的HMGB1。结果：本组患者行血浆置换后2 h血清HMGB1水平（3.67±0.93）ng/ml,较血浆置换前血清HMGB1水平（7.8±1.26）ng/ml显著下降,血浆置换后12 h血清HMGB1水平（5.18±0.93）ng/ml稍有回升,但仍低于血浆置换前浓度（P〈0.05）;血管炎活动指标（ESR、CRP、BVAS评分）较血浆置换前均降低。结论：血浆置换能有效清除AASV患者外周血清HMGB1,可明显降低疾病活动度。

Effects of Plasmapheresis on Serum HMGB1 Level in Patients with ANCA-associated Vasculitis

Objective：To investigate the effects of plasmapheresis on serum HMGBl level in patients with ANCA-associat-ed vasculitis（AAV）. Methods：13 patients with ANCA-associated vasculitis（female 3,male10,age 41~76 years）with new onset and active AAV were admitted to Department of Nephropathy of The First Hospital of Quanzhou Affiliated to Fujian Medical Universi-ty. BVAS scores were（21. 8 ± 4. 9）. 11 patients had serum positive P/MPO-ANCA,the others had serum positive C/PR3-AN-CA,and the average levels of ANCA were（295. 78 ± 52. 76）RU/ml. These patients were treated with glucocorticoid and corticoste-roid,on basis of which plasma exchange therapy was performed. Blood samples for determination of HMGB1 concentrations from 13 patients were collected before plasmuplercsis,during（2 hours after initiation）and 12 hours after plasmapheresis. The plasma levels of HMGB1 were determined by enzyme-linked immunosorbent assay. Results：Concentrations of HMGB1 of patients before plasmaph-eresis averaged（7. 8 ± 1. 26）ng/ml,（3. 67 ± 0. 93）ng/ml 2 hours after the initiation and slightly rose to（5. 18 ± 0. 93）ng/ml 12 hours after the treatment（P〈0. 05）. And the activity index of the disease（ESR、CRP、BVAS score）significantly declined. Conclu-sion：Plasmapheresis treatment significantly reduced serum levels of HMGB1 and controlled the condition of patients with AAV.