关键词: 抗中性粒细胞胞质抗体相关血管炎, 双重滤过血浆置换, 免疫吸附

Abstract: Ｏｂｊｅｃｔｉｖｅ：To investigate the efficacy and prognosis of double filtration plasmapheresis (DFPP) and immunoadsorption (IA) in antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) with severe kidney injury.
Ｍｅｔｈｏｄｏｌｏｇｙ：Twenty-seven patients diagnosed with AAV and with estimated glomerular filtration rate (eGFR) <30 mL/(min·1.73m2) were retrospectively collected from January 2022 to January 2024 at the National Clinical Medical Research Center for Kidney Diseases, Jinling Hospital, Affiliated to the Medical College of Nanjing University, and were divided into DFPP treatment group (DFPP group, n=10), IA treatment group (IA group, n=8) and standard hormone and immunosuppressant treatment group (the control group, n=9).The baseline conditions of the three groups, 12-month survival rates, renal survival rates and disease remission rates were analyzed.
Ｒｅｓｕｌｔｓ：There was no statistical difference in the general condition of the three groups. At 12 months of follow-up, no patient died in any of the three groups. By Kaplan-Meier analysis, there was no difference in renal survival rates or disease remission rates among the three groups of patients(χ2=4.668,P=0.097;χ2=0.296,P=0.862). Compared with pre-treatment, serum creatinine (SCr) and Birmingham Vasculitis Activity Score (BVAS) significantly decreased in all three groups after 1 month of treatment while eGFR significantly increased.However, there was no statistically significant difference in the percentage change of the above indexes between groups. MPO-ANCA titers decreased significantly after 1 month of treatment in the three groups, with a difference in the decline rate between the IA group and the control group (P=0.025), but no significant difference was observed between the other two groups. At 12 months of follow-up, there was no statistically significant difference in the incidence of adverse reactions among the three groups (P=0.847).
Ｃｏｎｃｌｕｓｉｏｎ：Both DFPP and IA can effectively treat AAV, showing a trend toward reducing the risk of progression to end-stage kidney disease. There was no significant difference in short-term efficacy, safety, and prognosis at 12 months between the two modalities. Fibrinogen decreased significantly during DFPP treatment, whereas IA had a lesser effect on fibrinogen, and it is necessary to focus on coagulation indexes during DFPP treatment to avoid the risk of hemorrhage.

Key words: anti-neutrophil cytoplasmic antibody-associated vasculitis, double filtration plasmapheresis, immunoadsorption