Mandai Shintaro, Nagahama Kiyotaka, Tsuura Yukio, Hirai Toshiyuki, Yoshioka Wakako, Takahashi Daiei, Aki Shota, Aoyagi Makoto, Tanaka Hiroyuki, Tamura Teiichi
Department of Nephrology, Yokosuka Kyosai Hospital, Japan.
Intern Med. 2011;50(15):1599-603. doi: 10.2169/internalmedicine.50.4939. Epub 2011 Aug 1.
A 40-year-old man with microscopic polyangiitis developed both myeloperoxidase anti-neutrophil cytoplasmic antibodies (90 EU) and anti-glomerular basement membrane antibodies (134 EU)-positive rapidly progressive glomerulonephritis and heparin-induced thrombocytopenia. Although the patient initially showed no signs of improvement, persistent therapy including 1 g/day intravenous methylprednisolone, 50 mg/day oral prednisolone, plasma exchange, and 900 mg/day intravenous cyclophosphamide resulted in the normalization of both titers, recovery of renal function, and discontinuation of dialysis. Though previous studies showed poor outcomes in such "double-positive" patients, aggressive immunosuppression in younger patients may result in the recovery of renal function, even in those with severe renal dysfunction.
一名患有显微镜下多血管炎的40岁男性，同时出现了髓过氧化物酶抗中性粒细胞胞浆抗体（90 EU）和抗肾小球基底膜抗体（134 EU）阳性的快速进展性肾小球肾炎以及肝素诱导的血小板减少症。尽管该患者最初没有改善迹象，但包括每日1 g静脉注射甲泼尼龙、每日50 mg口服泼尼松龙、血浆置换以及每日900 mg静脉注射环磷酰胺在内的持续治疗，使两种抗体滴度恢复正常，肾功能恢复，且停止了透析。尽管先前的研究表明此类“双阳性”患者预后不佳，但对年轻患者进行积极的免疫抑制治疗可能会使肾功能恢复，即使是那些有严重肾功能障碍的患者。
