Comparison Of Efficacy Of High Dosage Methylprednisolone And Combine With Plasmapheresis Treatment In Patients With ANCA Associated Vasculitis

Objective To compare the clinical efficacy and side-effects of high dosage methylprednisolone combine with plasmapheresis or only with high dosage methylprednisolone treatment in patients with anti-neutrophil Cytoplasmic antibodies(ANCA) associated vasculitis(AAV).Methods Forty-seven patients with clinicopathologically diagnosed as ANCA-associated vasculitis kidney damage, whose clinical manifestations were also consistent with rapidly progressive glomerulonephritis syndrome, were treated with high dosage methylprednisolone and plasmapheresis(PE group, n=22) or only with high dosage methylprednisolone(MP group,n=25). Patients received these two regimes were comparable in general conditions and clinicopathological parameters for the activity and severity of renal damage.Result At the 6 month, the serum level of ANCA were both lower significantly than before(P<0.05), and the PE group had the advantage to the MP group(P=0.028). The renal function was improved both in the two groups,and the serum creatinine of PE group was lower significantly than that in the MP group(P=0.043). The BVAS scores were both significantly decreased in the two groups(P<0.05),and the scores were lower in the PE group than that of the MP group(P<0.05). Both the serum albumin and hemoglobin levels in the two groups were significantly increased compared to the previous treatment(P<0.05),while the differences before and after treatment of the two levels between the two groups both have no significant difference(P>0.05).Three patients developed end stage renal failure in each groups during follow up. The incidence of gastrointestinal symptoms(12.0 % and 9.1 % in MP and PE group respectively)and infectious complications(28.0% and 22.7% in MP and PE group respectively)was similar in two groups.Conclusion Both the high dosage methylprednisolone combine plasmapheresis treatment and the high dosage methylprednisolone treatment have significant effects on patients with ANCA associated vaseulitis, while the high dosage methylprednisolone combine plasmapheresis treatment may more effectively decrease serum level of ANCA and improve renal function.