Gutschmidt H J, Euler H H, Albrecht J, Asbeck F, Kleine L H, von Klinggräff C, Löffler H
Dtsch Med Wochenschr. 1986 Sep 19;111(38):1439-44. doi: 10.1055/s-2008-1068648.
High-dosage stosstherapy of cyclophosphamide was administered, as far as possible optimally synchronized with plasmapheresis, to 12 patients with rapidly progressive glomerulonephritis. The basis for such synchronization lies in experimental data pointing to an increased antibody production after plasmapheresis (antibody rebound). Initial large-volume plasmapheresis was followed by high-dose immunosuppression in the phase of likely maximal proliferation of antibody-producing cells. The serum creatinine level in the 12 patients was 7.7 +/- 3.3 mg/dl before treatment. Eight patients required dialysis. After a period of observation of one year, ten patients are still alive. In one patient treatment had to be discontinued because she did not tolerate it. In the other nine patients renal function stabilized on a dialysis-free level. After one year the serum creatinine level averaged 2.5 +/- 1.2 mg/dl. With one exception no maintenance immunosuppressive treatment is required after one year. These preliminary results suggest that this treatment concept further improves the prognosis of rapidly progressive glomerulonephritis.
对12例快速进展性肾小球肾炎患者给予高剂量环磷酰胺冲击疗法，并尽可能使其与血浆置换最佳同步。这种同步的依据在于实验数据表明血浆置换后抗体产生增加（抗体反弹）。在可能处于抗体产生细胞最大增殖阶段时，先进行初始大剂量血浆置换，随后进行高剂量免疫抑制治疗。12例患者治疗前血清肌酐水平为7.7±3.3mg/dl。8例患者需要透析。经过一年的观察期，10例患者仍然存活。1例患者因不耐受而不得不停止治疗。其他9例患者的肾功能稳定在无需透析的水平。一年后血清肌酐水平平均为2.5±1.2mg/dl。除1例患者外，一年后无需维持免疫抑制治疗。这些初步结果表明，这种治疗方案进一步改善了快速进展性肾小球肾炎的预后。
