免疫吸附治疗脂蛋白肾病的疗效观察

目的：分析免疫吸附治疗脂蛋白肾病（LPG）的近期和远期疗效。方法：17例LPG患者，8例接受葡萄球菌蛋白A（SPA）免疫吸附治疗。比较免疫吸附和非免疫吸附患者治疗前后的尿蛋白、肾功能、血脂水平和病理改变及对肾功能的远期保护作用。结果：（1）免疫吸附治疗后患者尿蛋白、血清肌酐、胆固醇、三酰甘油及载脂蛋白E（ApoE）水平均明显下降（P〈0．05），重复肾活检示肾小球毛细血管袢内脂蛋白栓子显著减少或消失。（2）复发患者重复行免疫吸附治疗不仅能取得与第一疗程治疗相同的效果，并使疾病缓解期延长。（3）治疗后半年、1年及2年随访资料显示，吸附治疗组患者尿蛋白改善较非吸附组明显，且血清肌酐上升速度较非吸附组缓慢。吸附组血清肌酐上升50％的中位时间为67个月，非吸附组为6个月。结论：免疫吸附治疗能显著改善患者症状，使尿蛋白减少，肾功能改善。长期随访显示，吸附治疗有保护肾功能，延缓疾病进展的作用，对LPG患者定期行免疫吸附治疗有益于延缓疾病进展，改善患者预后。

Effect of immunoadsorption therapy in patients with lipoprotein glomerulopathy

Objective:To evaluate the short-term and long-term effects of immunoadsorption treatment in patients with lipoprotein glomerulopathy (LPG). Methodology:Seventeen patients with biopsy proven LPG were enrolled in this study. They were divided into two groups according to their treatment ways. Eight patients received immunoadsorption on protein A of the staphylococcus bacterium (SPA) plus routine treatment. The other 9 patients received only routine treatment. The levels of proteinuria,serum creatinine,plasma lipid and apoE before and after immunoadsorption treatment were compared. The long-term outcomes between the two groups were analysed. Results: (1) The levels of proteinuria,serum creatinine,plasma lipid and apoE were dramatically decreased (P<0.05) after immunoadsorption in all of the 8 patients. Repeated biopsy found the lipoprotein thrombi diminished or even disappeared. (2) The repeated immunoadsorption treatment in patients with relapse after the treatment showed the effective result as same as that of the first treatment,and the remission time has been prolonged in these patients. (3) Follow up data showed that the proteinuria and serum creatinine levels increased slower in patients who received immunoadsorption treatment than in patients of the control group after six-month,one-year and two-year follow-up. The median time that the serum creatinine increased 50 percent was 67 months for the patients who underwent immunoadsorption treatment,while it was 6 months for patients in the control group,but no statistical significance. Conclusion:We demonstrated that the immunoadsorption treatment for LPG did dramatically decrease proteinuria and improve renal function immediately after treatment. By comparing the two groups during the long-term follow-up,we found that the immunoadsorption treatment could protect renal function and delay the progression in patients with LPG.