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学科主题临床医学
Anti-Glomerular Basement Membrane Disease Outcomes of Different Therapeutic Regimens in a Large Single-Center Chinese Cohort Study
Cui, Zhao1,2; Zhao, Juan2; Jia, Xiao-yu2; Zhu, Sai-nan; Jin, Qi-zhuang2; Cheng, Xu-yang2; Zhao, Ming-hui2
刊名MEDICINE
2011-09-01
DOI10.1097/MD.0b013e31822f6f68
90期:5页:303-311
收录类别SCI
文章类型Article
WOS标题词Science & Technology
类目[WOS]Medicine, General & Internal
研究领域[WOS]General & Internal Medicine
关键词[WOS]NORMAL RENAL-FUNCTION ; ANTINEUTROPHIL CYTOPLASMIC AUTOANTIBODIES ; RAPIDLY PROGRESSIVE GLOMERULONEPHRITIS ; ANTIBODY-MEDIATED DISEASE ; GOODPASTURES-SYNDROME ; PLASMA-EXCHANGE ; GBM ANTIBODIES ; PROGNOSIS ; IMMUNOSUPPRESSION ; PLASMAPHERESIS
英文摘要

Anti-glomerular basement membrane (GBM) disease usually presents with rapidly progressive glomerulonephritis accompanied by pulmonary hemorrhage. The low incidence and fulminant course of disease preclude a large randomized controlled study to define the benefits of any given therapy. We conducted a retrospective survey of 221 consecutive patients seen from 1998 to 2008 in our hospital, and report here the patient and renal survival and the risk factors affecting the outcomes. Considering the similar clinical features of the patients, we could compare the effects of 3 different treatment regimens: 1) combination therapy of plasmapheresis and immunosuppression, 2) steroids and cytotoxic agents, and 3) steroids alone.

The patient and renal survival rates were 72.7% and 25.0%, respectively, at 1 year after disease presentation. The serum level of anti-GBM antibodies (increased by 20 U/mL; hazard ratio [HR], 1.16; p = 0.009) and the presentation of positive antineutrophil cytoplasmic antibodies (ANCA) (HR, 2.18; p = 0.028) were independent predictors for patient death. The serum creatinine at presentation (doubling from 1.5 mg/dL; HR, 2.07; p < 0.001) was an independent predictor for renal failure.

The combination therapy of plasmapheresis plus corticosteroids and cyclophosphamide had an overall beneficial effect on both patient survival (HR for patient mortality, 0.31; p = 0.001) and renal survival (HR for renal failure, 0.60; p = 0.032), particularly patient survival for those with Goodpasture syndrome (HR for patient mortality, 0.29; p = 0.004) and renal survival for those with anti-GBM nephritis with initial serum creatinine over 6.8 mg/dL (HR for renal failure, 0.52; p = 0.014). The treatment with corticosteroids plus cyclophosphamide was found not to improve the renal outcome of disease (p = 0.73).

In conclusion, the combination therapy was preferred for patients with anti-GBM disease, especially those with pulmonary hemorrhage or severe renal damage. Early diagnosis was crucial to improving outcomes.

语种英语
WOS记录号WOS:000294466500003
项目编号30725034 ; 30801020 ; 81021004
资助机构National Natural Science Foundation of China
引用统计
被引频次:39[WOS]   [WOS记录]     [WOS相关记录]
文献类型期刊论文
条目标识符http://ir.bjmu.edu.cn/handle/400002259/55010
专题北京大学第一临床医学院_肾脏内科
作者单位1.Peking Univ, Inst Nephrol, Beijing 100034, Peoples R China
2.Peking Univ, Renal Div, Dept Med,Inst Nephrol, Peking Univ Hosp 1,Key Lab Renal Dis,Minist Hlth, Beijing 100034, Peoples R China
推荐引用方式
GB/T 7714
Cui, Zhao,Zhao, Juan,Jia, Xiao-yu,et al. Anti-Glomerular Basement Membrane Disease Outcomes of Different Therapeutic Regimens in a Large Single-Center Chinese Cohort Study[J]. MEDICINE,2011,90(5):303-311.
APA Cui, Zhao.,Zhao, Juan.,Jia, Xiao-yu.,Zhu, Sai-nan.,Jin, Qi-zhuang.,...&Zhao, Ming-hui.(2011).Anti-Glomerular Basement Membrane Disease Outcomes of Different Therapeutic Regimens in a Large Single-Center Chinese Cohort Study.MEDICINE,90(5),303-311.
MLA Cui, Zhao,et al."Anti-Glomerular Basement Membrane Disease Outcomes of Different Therapeutic Regimens in a Large Single-Center Chinese Cohort Study".MEDICINE 90.5(2011):303-311.
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