摘要：背景:大剂量甲强龙冲击治疗是ANCA相关性血管炎 (AAV) 的主要治疗方法之一，但是有明显不良反应。我们旨在研究其对中国伴严重肾损伤AAV患者肾脏存活的影响，并发现其预后相关因素。

        方法:纳入111名估计的肾小球滤过率 (eGFR) ≤10ml/min/1.73 m2 的AAV患者。甲强龙组(n=57)接受静脉甲强龙500mg/日共3天，而对照组则不进行甲强龙冲击治疗(n=54)。比较两组的肾脏结局和不良反应。而且，分别使用Cox回归和ROC曲线法分析透析不依赖和对静脉甲强龙冲击治疗反应好的预测因素。

        结果:患者的平均随访时间是31 (范围3-134个月) 。甲强龙组11名患者和对照者20名患者死亡 (P=0.056)。甲强龙组21名患者 (36.8%) 和对照者 29 名患者(53.7%)维持透析 (P = 0.088)。甲强龙组不依赖透析患者有21名，高于对照组(4名患者, P<0.01)。尿蛋白肌酐比(危害比1.730, 95% 可信区间1.029-2.909, P=0.039)和静脉甲强龙冲击治疗 (危害比 0.362, 95% 可信区间0.190-0.690, P=0.002) 是透析不依赖的独立危险预测因素。诊断时肌酐≥855μmol/L和尿蛋白≥3.7g/24h 患者对静脉甲强龙冲击治疗反应更差(灵敏度56.7%, 特异度85.0%, 阳性预测值 100.0% ，阴性预测值 NPV57.1%)。

        结论:从透析不依赖性来看，静脉甲强龙冲击治疗可改善中国AAV患者长期预后，并倾向于降低死亡率。

        附原文：

        BACKGROUND:High-dosemethylprednisolone pulses were one of the main treatments for anti-neutrophilcytoplasmic autoantibody (ANCA) associated vasculitides (AAV) but had obviousside effects. We aimed to know the impact on renal survival and identify theprognostic factors of this treatment in Chinese AAV patients with severe renalinvolvement.METHODS:Onehundred and eleven AAV patients with an estimated glomerular filtration rate(eGFR) of 10ml/min/1.73 m2or less at admission were included.The MP group (n=57) received intravenousmethylprednisolone 500 mg/d for 3 days, while the control group (n=54)had not. The outcomes and adverse events between two groups were compared.Besides, predictors for dialysis independence and good response of intravenousmethylprednisolone were analyzed using Cox regression analysis and ROC curvesrespectively.RESULTS:Theirmedian duration of follow-up was 31 (range 3 to 134) months. Eleven patients inMP group and 20 patients in control group were died (P=0.056).Twenty-one patients (36.8%) in MP group and 29 patients (53.7%) in controlgroup were on maintaining dialysis (P = 0.088). Twenty-one patients in MP groupremained dialysis independent, more than those in control group (4 patients, P<0.01).Urine protein creatinine ratio (hazard ratio 1.730, 95% confidence interval1.029 to 2.909, P=0.039) and the treatment of intravenousmethylprednisolone pulses (hazard ratio 0.362, 95% confidence interval 0.190 to0.690, P=0.002) were the independent riskfactors for dialysis independence. Those patients with serumcreatinine≥855μmol/L and urine protein ≥3.7g/24h at admission may have worseresponses to intravenous methylprednisolone pulses (sensibility 56.7%,specificity 85.0%, PPV 100.0% and NPV57.1%).CONCLUSIONS:Intravenous methylprednisolonepulses could improve the long-term outcome in term of dialysis independence andtend to decrease mortality for Chinese AAV patients with severe renalinvolvement.

        引自：Ma Y,Han F,Chen L,Wang H,Han H,Yu B,Xu Y,Chen J.The impact of intravenous methylprednisolone pulses onrenal survival in anti-neutrophil cytoplasmic antibodyassociatedvasculitiswith severe renal injury patients: aretrospective study.BMC Nephrol.2017Dec 29;18(1):381. doi: 10.1186/s12882-017-0782-4.