关键词: 吗替麦考酚酯, 血管炎, 抗中性粒细胞胞质抗体, 存活率, 预后

Abstract:

Objective: To retrospectively analyze the effects of corticosteroids with mycophenolate mofetil （MMF）treatment on long-term outcome in ANCA associated vasculitis (AAV) patients with renal involvement. Methodology: Fifty one AAV patients with renal involvement (male 21, female 30, average age 46.4±15.8 years ) from January 2000 to June 2012 were enrolled in the study, The baseline median BVAS score was 13 and serum creatinine (SCr) was 2.3±1.2mg/dl. All patients received corticosteroids in combined with MMF (1-2.0g/d) for induction therapy, among them 14 patients received immunoadsorption (n=11) or double filtration plasmapheresis additionally (n=3), after remission corticosteroids in combined with MMF was given continue for maintenance therapy. The clinical effects, patient and renal survival of corticosteroids with MMF in AAV with renal involvement were investigated. Results: The patients were treated with MMF for 3~120 months (median of 23 mths) and had a follow-up time from 3 to 155 months (median of 56 mths). In the induction stage with MMF, 46 (90.2%) patients achieved remission and went into the maintenance therapy, one died because of pulmonary infection, one developed to end stage renal disease (ESRD), and 3 patients had no response to the therapy. During the follow-up, 3 patients died of pulmonary infection, the cumulative patient survival at 3 and 5 year was both 93.2%, and 7 patients developed to ESRD, the cumulative renal survival at 3 and 5year was 91.8% and 83.0%. 13 cases (28.3%) relapsed, the median relapse time was 43 months, accumulated relapse rate at 3 and 5 year was 13.2%% and 25.6%. A total of 29 adverse reactions occurred in 21 (41.2%) patients, including infection (n=27) and hyperglycemia (n=2), among them 16 were pulmonary infection. Conclusion: Corticosteroids with MMF was effective for treating AAV with renal involvement, while pulmonary infection was the common complication and cause of death. Further large-scale multicentre randomized controlled trials will be needed to confirm these findings.
Key words

Key words: Mycophenolate mofetil Vasculitis, ANCA , patient/renal , survival