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題名 | Effects of the Methylprednisolone Pulse Therapy on Renal Function=大劑量類固醇脈衝療法對腎功能影響的臨床意義 |
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作者 | 劉津秀; 謝松洲; 吳政翰; 余家利; | 書刊名 | 中華民國風濕病雜誌 |
卷期 | 21:2 2007.12[民96.12] |
頁次 | 頁6-12 |
分類號 | 415.95 |
關鍵詞 | 類固醇脈衝治療; 腎功能; 腎衰竭; 白蛋白; 抗雙股DNA抗體; Pulse therapy; Methylprednisolone; Renal failure; Albumin; Anti-dsDNA; |
語文 | 英文(English) |
中文摘要 | 目的:研究大劑量類固醇脈衝療法對腎功能的影響及分析相關影響因子。 材料與方法:收集從民國 94 年12 月至民國 95 年7月,在台大醫院風濕免疫科住院的自體免疫病人,共有 49 人接受每日一千毫克類固醇的脈衝療法,連續三日,同時並收集分析相關資料,包括年齡、性別、疾病表徵、實驗室檢查、脈衝療法前後的血清肌酸酐、二十四小時尿液體積、肌酸酐及其廓清率變化。 結果:共分為兩組,其中一組為併發腎炎的病人,含紅斑性狼瘡或乾燥症,另一組為沒有併發腎炎的病人。兩組相較,有腎炎的病人有較高比例,出現白血球低下、補體缺少、及陽性抗核抗體、SSA/SSB 抗體。只有一位患腎病症候群及慢性腎衰竭的病人,在接受大劑量類固醇脈衝治療後,出現腎功能急性惡化。值得注意的是,併發有腎炎的病人,經大劑量類固醇脈衝治療後,二十四小時肌酸酐廓清率會上升,相反地,在無腎炎的病人,其二十四小時肌酸酐廓清率反而下降,只是這兩組數據都未達到統計學上的意義。依據迴歸分析的結果,在併發腎炎的自體免疫病病人,其血清白蛋白值愈高 (>3.5 mg/dL) ,對接受大劑量類固醇脈衝治療療效愈佳,其二十四小時肌酸酐廓清率明顯上升。 結論:類固醇的抗發炎及免疫抑制作用仍是目前治療自體免疫病最有效的療法之一。對大部分的病人,大劑量類固醇脈衝治療並不會導致臨床上明顯的腎功能惡化,同時對併發腎炎的自體免疫患者,可改善其腎功能。只有當病人的血清白蛋白過低 (<2.0 mg/dL) 或腎功能顯著異常 (Cr >2.0 mg/dL) 時,脈衝療法才易導致急性腎功能惡化,要特別小心追蹤。 |
英文摘要 | Objective: To clarify the effect of the methylprednisolone (MP) pulse therapy on renal function and analyze the risk factors. Methods: Forty-nine patients with collagen vascular diseases were included, of whom 26 patients were assigned in nephritis group with SLE or Sjögren’s syndrome and the other 23 patients were in the group without renal involvements. Results: Before the MP pulse therapy, the nephritis group showed a significantly higher prevalence of leukopenia (p=0.028), low C3/C4 (p<0.001), positive ANA (p=0.015), and positive SSA/SSB (p<0.001) when compared with the group without nephritis. After 3-consecutive-day pulse therapy of 1000 mg MP, only one patient with nephrotic syndrome and chronic renal failure suffered from deteriorated renal failure. There were no clinically significant changes on glomerular filtration rate, serum creatinine and fluid retention after MP pulse therapy in both groups. Interestingly, a trend of the increase of creatinine clearance rate (Ccr) (p=0.185) was found in nephritis group, while a trend of the decrease of Ccr (p=0.263) was found in non-nephritis group instead (though not statistically significant). We also found that albumin >3.5 mg/dL in the nephritis group before the MP pulse therapy (p=0.023) could predict the improvement of Ccr after the MP pulse therapy, which showed serum albumin level could be the most important indicator for the adverse effect on renal function during MP pulse therapy. Conclusion: Intravenous MP pulse therapy is the potent anti-inflammatory and immunosuppressive therapy for inflammatory autoimmune disease. From our finding, MP pulse therapy is effective for autoimmune diseases with renal involvement. In addition to treatment benefit, the adverse effect on renal function of MP pulse therapy is not significant if the patient’s albumin is more than 2.0 mg/dL, creatinine less than 2.0 mg/dL and Ccr more than 30 ml/min. |
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