PLASMA-EXCHANGE IN FOCAL NECROTIZING GLOMERULONEPHRITIS WITHOUT ANTI-GBM ANTIBODIES
PLASMA-EXCHANGE IN FOCAL NECROTIZING GLOMERULONEPHRITIS WITHOUT ANTI-GBM ANTIBODIES
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DOI：
10.1038/ki.1991.272
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发表时间：
1991-10-01
影响因子：
19.6
通讯作者：
LOCKWOOD, CM
中科院分区：
文献类型：
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作者：
PUSEY, CD;REES, AJ;LOCKWOOD, CM
为了确定口服免疫抑制剂治疗局灶性坏死性肾小球肾炎（无抗GBM抗体）患者的血浆置换是否有额外的益处，我们进行了一项随机对照试验，入组时对肾功能进行分层。 分析了48例病例，其中治疗组25例（血浆置换、泼尼松龙、环磷酰胺和硫唑嘌呤），对照组23例（仅药物治疗）。 血清肌酐< 500 μ mol/L（N = 17）或> 500 μ mol/L但未接受透析（N = 12）的患者的结局无差异，除1人外，所有患者均在4周内改善。 然而，最初依赖透析的患者（N = 19）如果接受血浆置换和药物治疗（10/11）而不是单独使用药物（3/8），则更有可能恢复肾功能（P = 0.041）。 长期随访显示，肾功能的改善通常得以维持。 本试验的结果证实，与系统性血管炎相关的局灶性坏死性肾小球肾炎在早期开始治疗时对免疫抑制药物反应良好，并表明血浆置换在透析依赖性病例中具有额外的益处。
To determine whether plasma exchange was of additional benefit in patients treated with oral immunosuppressive drugs for focal necrotizing glomerulonephritis (without anti-GBM antibodies), we performed a randomized controlled trial with stratification for renal function on entry. Forty-eight cases were analyzed, 25 in the treatment group (plasma exchange, prednisolone, cyclophosphamide and azathioprine) and 23 in the control group (drug therapy only). There was no difference in outcome in patients presenting with serum creatinine < 500-mu-mol/liter (N = 17), or > 500-mu-mol/liter but not on dialysis (N = 12), all but one of whom had improved by four weeks. However, patients who were initially dialysis-dependent (N = 19) were more likely to have recovered renal function (P = 0.041) if treated with plasma exchange as well as drugs (10 of 11) rather than with drugs alone (3 of 8). Long-term follow-up showed that improvement in renal function was generally maintained. The results of this trial confirm that focal necrotizing glomerulonephritis related to systemic vasculitis responds well to immunosuppressive drugs when treatment is started early, and suggest that plasma exchange is of additional benefit in dialysis-dependent cases.