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中华肾病研究电子杂志 ›› 2012, Vol. 01 ›› Issue (02) : 90 -93. doi: 10.3877/cma.j.issn.2095-3216.2012.02.006

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抗中性粒细胞胞浆抗体相关性肾炎的循证治疗
陈旻1, 赵明辉1,()   
  1. 1.100034 北京,北京大学第一医院肾内科
  • 收稿日期:2012-10-29 出版日期:2012-12-18
  • 通信作者: 赵明辉

Evidence-based treatment for antineutrophil cytoplasmic antibody-associated glomerulonephritis

Min CHEN1, Ming-hui ZHAO1,()   

  1. 1.Renal Division, Peking University First Hospital, Beijing 100034, China
  • Received:2012-10-29 Published:2012-12-18
  • Corresponding author: Ming-hui ZHAO
引用本文:

陈旻, 赵明辉. 抗中性粒细胞胞浆抗体相关性肾炎的循证治疗[J/OL]. 中华肾病研究电子杂志, 2012, 01(02): 90-93.

Min CHEN, Ming-hui ZHAO. Evidence-based treatment for antineutrophil cytoplasmic antibody-associated glomerulonephritis[J/OL]. Chinese Journal of Kidney Disease Investigation(Electronic Edition), 2012, 01(02): 90-93.

抗中性粒细胞胞浆抗体相关小血管炎是一组累及全身多系统的疾病,肾脏是其最常受累的器官,其治疗分为初始治疗、维持治疗和复发治疗,初始治疗应用糖皮质激素联合细胞毒性药物(特别是环磷酰胺或利妥昔单抗),对于重症患者可采取大剂量甲泼尼龙冲击和(或)血浆置换治疗。维持治疗主要是长期应用免疫抑制剂治疗,特别是硫唑嘌呤或吗替麦考酚酯等。复发的患者可以根据其复发的程度适当增加糖皮质激素和(或)免疫抑制剂的剂量,严重者则需要重新应用初始治疗。

Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis is a group of autoimmune diseases. The kidney is the most commonly involved organ, which is termed as ANCAassociated glomerulonephritis. According to the “Kidney Disease: Improving Global Outcomes (KDIGO)”guideline, the treatment for ANCA-associated glomerulonephritis includes initial treatment, maintenance treatment and treatment for relapses. For initial treatment, the first line protocol is the combination of corticosteroids and cyclophosphamide. Rituximab is an alternative choice for cyclophosphamide.Plasma exchange or pulse methylprednisolone are employed in the severe patients. Choices of agents for maintenance therapy mainly include azathioprine and MMF. Treatment for relapse may be either reinstituting of initial therapy or simply increasing the dose of corticosteroids/immunosuppressant,according to the severity of relapse.

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