摘要：背景:大劑量甲強龍衝擊治療是ANCA相關性血管炎 (AAV) 的主要治療方法之一，但是有明顯不良反應。我們旨在研究其對中國伴嚴重腎損傷AAV患者腎髒存活的影響，並發現其預後相關因素。
方法:納入111名估計的腎小球濾過率 (eGFR) ≤10ml/min/1.73 m2 的AAV患者。甲強龍組(n=57)接受靜脈甲強龍500mg/日共3天，而對照組則不進行甲強龍衝擊治療(n=54)。比較兩組的腎髒結局和不良反應。而且，分別使用Cox回歸和ROC曲線法分析透析不依賴和對靜脈甲強龍衝擊治療反應好的預測因素。
結果:患者的平均隨訪時間是31 (範圍3-134個月) 。甲強龍組11名患者和對照者20名患者死亡 (P=0.056)。甲強龍組21名患者 (36.8%) 和對照者 29 名患者(53.7%)維持透析 (P = 0.088)。甲強龍組不依賴透析患者有21名，高於對照組(4名患者, P<0.01)。尿蛋白肌酐比(危害比1.730, 95% 可信區間1.029-2.909, P=0.039)和靜脈甲強龍衝擊治療 (危害比 0.362, 95% 可信區間0.190-0.690, P=0.002) 是透析不依賴的獨立危險預測因素。診斷時肌酐≥855μmol/L和尿蛋白≥3.7g/24h 患者對靜脈甲強龍衝擊治療反應更差(靈敏度56.7%, 特異度85.0%, 陽性預測值 100.0% ，陰性預測值 NPV57.1%)。
結論:從透析不依賴性來看，靜脈甲強龍衝擊治療可改善中國AAV患者長期預後，並傾向於降低死亡率。
附原文：
BACKGROUND:High-dosemethylprednisolone pulses were one of the main treatments for anti-neutrophilcytoplasmic autoantibody (ANCA) associated vasculitides (AAV) but had obviousside effects. We aimed to know the impact on renal survival and identify theprognostic factors of this treatment in Chinese AAV patients with severe renalinvolvement.METHODS:Onehundred and eleven AAV patients with an estimated glomerular filtration rate(eGFR) of 10ml/min/1.73 m2or less at admission were included.The MP group (n=57) received intravenousmethylprednisolone 500 mg/d for 3 days, while the control group (n=54)had not. The outcomes and adverse events between two groups were compared.Besides, predictors for dialysis independence and good response of intravenousmethylprednisolone were analyzed using Cox regression analysis and ROC curvesrespectively.RESULTS:Theirmedian duration of follow-up was 31 (range 3 to 134) months. Eleven patients inMP group and 20 patients in control group were died (P=0.056).Twenty-one patients (36.8%) in MP group and 29 patients (53.7%) in controlgroup were on maintaining dialysis (P = 0.088). Twenty-one patients in MP groupremained dialysis independent, more than those in control group (4 patients, P<0.01).Urine protein creatinine ratio (hazard ratio 1.730, 95% confidence interval1.029 to 2.909, P=0.039) and the treatment of intravenousmethylprednisolone pulses (hazard ratio 0.362, 95% confidence interval 0.190 to0.690, P=0.002) were the independent riskfactors for dialysis independence. Those patients with serumcreatinine≥855μmol/L and urine protein ≥3.7g/24h at admission may have worseresponses to intravenous methylprednisolone pulses (sensibility 56.7%,specificity 85.0%, PPV 100.0% and NPV57.1%).CONCLUSIONS:Intravenous methylprednisolonepulses could improve the long-term outcome in term of dialysis independence andtend to decrease mortality for Chinese AAV patients with severe renalinvolvement.
引自：Ma Y,Han F,Chen L,Wang H,Han H,Yu B,Xu Y,Chen J.The impact of intravenous methylprednisolone pulses onrenal survival in anti-neutrophil cytoplasmic antibodyassociatedvasculitiswith severe renal injury patients: aretrospective study.BMC Nephrol.2017Dec 29;18(1):381. doi: 10.1186/s12882-017-0782-4.
