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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 after emergency hemodialysis (hemodialysis) in patients with renal failure of anti-neutrophil cytoplasmic antibodies (ANCA) associated vasculitis (ANCA) associated vasculitis (AAV). Methods: The clinical data of patients who underwent primary hemodialysis with acute renal failure treated with AAV from January 2006 to January 2016 were collected and analyzed (out of dialysis, death within 3 months, maintenance dialysis) And risk factors. The patients who entered into maintenance dialysis were divided into peritoneal dialysis (dialysis) and hemodialysis 2 groups for comparison. RESULTS: A total of 58 patients were enrolled. Nine patients recovered from renal function and got rid of dialysis. Twenty-four patients died within three months after initial dialysis. The main causes of early death were pulmonary infection and disease activity. The death group was older than the survival group (P = 0.001), the Birmingham vasculitis activity score (BVAS) was higher (P = 0.048), and the platelet level was lower (P = 0.004). Logistic regression analysis showed that the high BVAS score (OR = 1.160, 95% CI 1.005-1.393) and the low platelet count (OR 1.011, 95% CI 1.002 ~ 1.021) is a risk factor for early death in AAV patients with renal failure. Twenty-five patients underwent maintenance dialysis (10 in peritoneal dialysis and 15 in hemodialysis). At 6 months of dialysis, BVAS decreased from 15 points (13 points, 18 points) at baseline to 2 points (2 points, 4 points) (P = 0.001); and the hemodialysis group maintained dialysis for 6 months BVAS decreased from 16 points at baseline (14 points, 21 points) to 4 points (2 points, 6 points) (P = 0.001). There were no significant differences in hemoglobin and serum albumin levels between the two groups at 6 months, 1 year and 2 years (P> 0.05). There were 2 patients in the hemodialysis group during follow-up and 4 patients in the peritoneal dialysis group, while the lung infection was the main cause of death. There was no significant difference in the long-term survival rate between the two groups (P = 0.235). CONCLUSION: The elderly, high BVAS score and low platelet count are the risk factors of early death in AAV patients with renal failure. After maintenance dialysis, vasculitis activity was controlled in both the hemodialysis group and the peritoneal dialysis group, with long-term survival rates similar between the two groups, whereas lung infection was the predominant death in this population during early and maintenance dialysis sessions the reason.