抗中性粒细胞浆抗体相关性血管炎与肾功能衰竭救治的疗效评价

目的：评价抗中性粒细胞胞浆抗体相关性血管炎（ASV）肾脏损害及救治疗效。方法：1997．10－2001．3间确诊ASV56例，急诊肾穿刺活检21／56例，依据病情活动度和病损程度分别予以双冲击、单冲击、单纯激素和（或）小剂量CTX、单纯或联合血液净化，追踪缓解率。结果：ASV中肾累及率96．4％，肾功能衰竭（肾衰）91．1％，急性肾衰82．1％，重度肾衰48．2％，病理以新月体性肾炎和局灶段性肾炎常见。病死率19．6％，缓解率67．9％，失访率12．5％。结论：ASV患者肾损害发生率高，病情重；应强调“个体化”，早期治疗、合理干预，加强随访，急诊肾活检有助完善诊断；已进展至终末期者仍有免疫抑制剂应用指征。

Evaluation of therapeutic effects on ANCA-associated vasculitis and renal failure

Objective To evaluate the renal involvement and therapeutic effect on ANCA-associated vasculitis(ASV) . Methods Fifty-six cases were diagnosed as ASV from Oct 1997 to Mar 2001. Among them, 21 cases received renal biopsies. According to disease activity and severity, Use following treatment protocols were choosed: (1) double pulse therapy; (2) single pulse therapy; (3) oral prednisone and/or low dose of CTX; (4) blood purification technique and/or immunosuppressive therapy. Remission rate was also analyzed. Results 96. 4% of case suffered with renal involvement. 91. 1% with acute renal failure, 96.4% with severe renal failure, 98. 2% with multiple organs involvement. The mortality was 19. 6% and the remission rate 67. 9%. 12. 5% of cases lost follow-up. ConclusionsRenal involvement is common and serious in ASV patients. Individualized and early therapy, as well as valuable urgent renal biopsy are necessary. To those who have entered ESRD, immunosuppressive agents could be used to decrease the extra-renal complication.