目的: 分析抗中性粒细胞胞质抗体（anti-neutrophil cytoplasmic antibodies, ANCA）相关性血管炎（ANCA associated vasculitis,AAV）肾衰竭患者行急诊血液透析（血透）后的转归及危险因素。方法: 收集2006年1月至2016年1月我科收治的初次确诊为AAV肾衰竭并行急诊血透治疗患者的临床资料,分析其转归（摆脱透析、3个月内死亡、维持性透析）及危险因素。将进入维持性透析的患者分为腹膜透析（腹透）、血透2组进行比较。结果: 共纳入58例患者,9例肾功能恢复而摆脱透析,24例于初次透析后3个月内死亡,早期死亡原因主要为肺部感染、疾病活动。死亡组较存活组年龄更大（P=0.001）、伯明翰血管炎活动评分（Birmingham vasculitis activity score, BVAS）更高（P=0.048）、血小板水平更低（P=0.004）。Logistic 回归分析示,高龄（OR=1.087,95% CI为 1.014~1.165）、高BVAS分值（OR=1.160,95% CI为1.005~1.339）、低血小板计数（OR=1.011,95% CI为1.002~1.021）为AAV肾衰竭患者早期死亡的危险因素。25例患者进入维持性透析（腹透 10例,血透15例）。透析6个月时,腹透组的BVAS由基线时的15分（13分,18分）降至2分（2分,4分）（P=0.001）;血透组维持性透析6个月时的BVAS由基线时的16分（14分,21分）降至4分（2分,6分）（P=0.001）。2组间透析6个月、1年、2年时的血红蛋白、血清白蛋白水平差异无统计学意义（P>0.05）。随访期间血透组有2例患者、腹透组有4例患者死亡,而肺部感染为其主要死亡原因,2组间的长期生存率差异无统计学意义（P=0.235）。结论: 高龄、高BVAS分值、低血小板计数是AAV肾衰竭患者早期死亡的危险因素。进入维持性透析治疗后,血透组和腹透组的血管炎活动性均可得到控制,2组间的长期生存率相似,而肺部感染是此人群在早期和维持性透析期死亡的主要原因。
Objective: To analyze the outcome and risk factors of patients with renal failure due to ANCA-associated vasculitis(AAV) after emergency hemodialysis. Methods: The clinical data of patients diagnosed as renal failure due to AAV and treated with emergency hemodialysis from Jan. 2006 to Jan.2016 were recruited, and the outcome (renal reco-very, death within 3 months, maintenance dialysis) and risk factors were analyzed. The survival patients who came into maintaining dialysis were divided into two groups: the peritoneal dialysis group and hemodialysis group. Results: A total of 58 patients were enrolled. Renal function of 9 patients recovered after emergency hemodialysis; 24 patients died within 3 months, and the main causes of death were pneumonia and disease activity. The patients died had older age (P=0.001), higher BVAS scores (P=0.048), lower level of platelets (P=0.004) than that of survival patients. Logistic regression analysis showed that old age (OR=1.087, 95% CI: 1.014-1.165), high BVAS scores (OR=1.160, 95% CI: 1.005-1.339), low level of platelets (OR=1.011, 95% CI: 1.002-1.021 ) were risk factors for early death. Twenty-five patients came into maintaining dialysis, including 10 cases with peritoneal dialysis (PD) and 15 cases with hemodialysis (HD). At 6 months after dialysis, BVAS scores of PD group reduced from baseline 15 (13,18) to 2 (2,4) (P=0.001); BVAS scores of HD group decreased from baseline 16 (14,21) to 4 (2,6) (P=0.001). There were no significant differences in hemoglobin, serum albumin between the two groups at 6 months, 1 year and 2 years (P>0.05). Two HD patients and four PD patients died during follow-up, and pneumonia was the main cause of death. The difference in long-term survival rate between the two groups was not significant (P=0.235). Conclusions: Old age, high BVAS scores, low level of platelets are risk factors for death of patients with renal failure due to AAV in early period. On maintaining dialysis, the control of vasculitis activity and long-term survival rate are similar between HD and PD groups. Pneumonia is the main cause of death both in early period and on maintai-ning dialysis.
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