Department of Medicine-Nephrology, St Joseph's Hospital, McMaster University, Hamilton, Ontario, Canada.
Kidney Int. 2013 Aug;84(2):397-402. doi: 10.1038/ki.2013.131. Epub 2013 Apr 24.
Patients with antineutrophil cytoplasm antibody-associated vasculitis (AAV) requiring dialysis at diagnosis are at risk for developing end-stage renal disease (ESRD) or dying. Short-term results of a trial comparing plasma exchange (PLEX) to intravenous methylprednisolone (IV MeP) suggested PLEX improved renal recovery. Here we conducted long-term follow-up to see if this trend persisted. A total of 137 patients with newly diagnosed AAV and a serum creatinine over 500 μmol/l or requiring dialysis were randomized such that 69 received PLEX and 68 received IV MeP in addition to cyclophosphamide and oral glucocorticoids. The patients were followed for a median of 3.95 years. In each group there were 35 deaths, while 23 PLEX and 33 IV MeP patients developed ESRD. The hazard ratio for PLEX compared to IV MeP for the primary composite outcome of death or ESRD was 0.81 (95% confidence interval 0.53-1.23). The hazard ratio for all-cause death was 1.08 with a subhazard ratio for ESRD of 0.64 (95% confidence interval 0.40-1.05). Thus, although short-term results with PLEX are encouraging, the long-term benefits remain unclear. Further research is required to determine the role of PLEX in AAV. Given the poor outcomes of patients with severe AAV, improved treatment is urgently needed.
患有抗中性粒细胞胞浆抗体相关性血管炎（AAV）并在诊断时需要透析的患者有发展为终末期肾病（ESRD）或死亡的风险。一项比较血浆置换（PLEX）与静脉甲基强的松龙（IV MeP）的试验的短期结果表明，PLEX 改善了肾脏恢复。在这里，我们进行了长期随访，以观察这种趋势是否持续。共有 137 名新诊断的 AAV 患者和血清肌酐>500 μmol/L 或需要透析的患者被随机分为两组，69 名接受 PLEX，68 名接受 IV MeP，外加环磷酰胺和口服糖皮质激素。患者的中位随访时间为 3.95 年。每组有 35 人死亡，而 23 名 PLEX 和 33 名 IV MeP 患者发展为 ESRD。与 IV MeP 相比，PLEX 治疗的主要复合终点（死亡或 ESRD）的风险比为 0.81（95%置信区间 0.53-1.23）。全因死亡的风险比为 1.08，ESRD 的亚风险比为 0.64（95%置信区间 0.40-1.05）。因此，尽管 PLEX 的短期结果令人鼓舞，但长期益处仍不清楚。需要进一步研究来确定 PLEX 在 AAV 中的作用。鉴于严重 AAV 患者的预后较差，迫切需要改进治疗。
