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[抗中性粒细胞胞浆抗体相关血管炎的现行指南:共同特征与差异]

[Current guidelines on ANCA-associated vasculitides : Common features and differences].

作者信息

Hellmich B

机构信息

Vaskulitiszentrum Süd, Klinik für Innere Medizin, Rheumatologie und Immunologie, Klinik Kirchheim, Akademisches Lehrkrankenhaus der Universität Tübingen, Eugenstr. 3, 73230, Kirchheim u. Teck, Deutschland.

出版信息

Z Rheumatol. 2017 Mar;76(2):133-142. doi: 10.1007/s00393-016-0223-y.

Abstract

The results of a number of prospective randomized controlled clinical trials have led to changes in established strategies for the treatment of antineutrophil cytoplasmic antibody (ANCA) associated vasculitides (AAV) in recent years. Since 2014, a total of 4 scientific societies and study groups have systematically reviewed the new data and have formulated evidence-based recommendations for the management of AAV based on the analysis. These recommendations contain information on diagnosis, treatment (induction and maintenance), supportive care and monitoring of disease activity and resulting damage. This review compares the recently published recommendations of the German Society of Rheumatology (Deutschen Gesellschaft für Rheumatologie, DGRh), the European League Against Rheumatism (EULAR)/European Renal Association (ERA), the British Society of Rheumatology (BSR) and the Canadian Vasculitis Research Network (CanVasc). The comparative analysis reveals a high level of agreement on numerous topics but also shows some minor and even a few major differences in the respective recommended approach to diagnosis and treatment of AAV. Divergent recommendations predominantly exist in areas with little scientific evidence from clinical studies. Furthermore, some differences result from different interpretation of existing data or are influenced by characteristic features of the respective national healthcare system.

摘要

近年来,多项前瞻性随机对照临床试验的结果促使抗中性粒细胞胞浆抗体(ANCA)相关血管炎(AAV)既定治疗策略发生了变化。自2014年以来,共有4个科学协会和研究小组系统地回顾了新数据,并在分析的基础上制定了基于证据的AAV管理建议。这些建议包含有关诊断、治疗(诱导和维持)、支持治疗以及疾病活动和所致损害监测的信息。本综述比较了德国风湿病学会(DGRh)、欧洲抗风湿病联盟(EULAR)/欧洲肾脏协会(ERA)、英国风湿病学会(BSR)和加拿大血管炎研究网络(CanVasc)最近发布的建议。比较分析显示,在众多主题上达成了高度一致,但在AAV诊断和治疗的各自推荐方法上也存在一些细微甚至一些重大差异。不同的建议主要存在于临床研究科学证据较少的领域。此外,一些差异源于对现有数据的不同解读,或受各自国家医疗保健系统特征的影响。

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