紫癜性肾炎的治疗.ppt

2020/6/14,TheFirstHospitalofXinxiangMedicalCollege,1,紫癜性肾炎的治疗ThetreatmentofHSPN,朱铁锤,2020/6/14,TheFirstHospitalofXinxiangMedicalCollege,2,概述,继发于过敏性紫癜，最严重的并发症20-40%儿童HSP50-85%成人HSP影响预后及病程决定因素,2020/6/14,TheFirstHospitalofXinxiangMedicalCollege,3,2020/6/14,TheFirstHospitalofXinxiangMedicalCollege,4,2020/6/14,TheFirstHospitalofXinxiangMedicalCollege,5,治疗,肾外表现的治疗HSPN的治疗,2020/6/14,TheFirstHospitalofXinxiangMedicalCollege,6,肾外表现的治疗,解热镇痛药物抗组胺及解痉药物糖皮质激素,2020/6/14,TheFirstHospitalofXinxiangMedicalCollege,7,HSPN的治疗糖皮质激素,尿常规轻度改变：镜下血尿轻微蛋白尿肾功能正常肾活检轻微改变局灶性增生杀鸡焉用宰牛刀,2020/6/14,TheFirstHospitalofXinxiangMedicalCollege,8,HSPN的治疗糖皮质激素,肾炎综合征肾病综合征急进性肾炎系膜增生性肾炎伴局灶或弥漫性新月体膜增殖性肾炎舍我其谁？,2020/6/14,TheFirstHospitalofXinxiangMedicalCollege,9,HSPN的治疗糖皮质激素,是否应用多少剂量多久疗程多大疗效上帝知道，他老人家说：一个字乱两个字真乱三个字就是乱,2020/6/14,TheFirstHospitalofXinxiangMedicalCollege,10,HSPN的治疗应用糖皮质激素最大学派,急性肾炎综合征泼尼松1-2mg/kg.d疗程2-3月大量蛋白尿MP冲击治疗15-30mg/kg.d必要时追加1-2疗程泼尼松1-2mg/kg.d维持疗程6个月,2020/6/14,TheFirstHospitalofXinxiangMedicalCollege,11,刘志红、黎磊石的不同声音,轻度（镜下血尿少量蛋白尿oneyear,2020/6/14,TheFirstHospitalofXinxiangMedicalCollege,12,刘志红、黎磊石的不同声音,中度（肉眼血尿大量镜下血尿蛋白尿2.0g/24h高血压轻度肾功能损害肾小球弥漫增殖或局灶节段硬化新月体twoyear,2020/6/14,TheFirstHospitalofXinxiangMedicalCollege,13,刘志红、黎磊石的不同声音,重度（肉眼血尿大量蛋白尿高血压肾功能损害急进性肾炎肾小球重度增殖或膜增殖样病变大量新月体）MP0.5X3D泼尼松0.5mg/kg.d四周后改隔日顿服10mg维持富翁MMF2.0/D半年1.5/D半年1.0/D1年负翁CTX雷公藤多苷1mg/kg.d新肾炎胶囊100mgbid总疗程twoyear,2020/6/14,TheFirstHospitalofXinxiangMedicalCollege,14,邓安国说：,急性肾炎综合症泼尼松0.8-1.0mg/kg.d6-8周减量总疗程6月较重急性肾炎综合症especially弥漫增生泼尼松4周无效CTX总疗程可12月大量蛋白尿或NS泼尼松1.0mg/kg.d若无效连用雷公藤多苷或MMF若4周还无效应用MP冲击急进性肾炎MP或CTX冲击病情凶险双冲击,2020/6/14,TheFirstHospitalofXinxiangMedicalCollege,15,HSPN的治疗免疫抑制剂,属上层建筑一般治疗无效的肾炎综合征、肾病综合征急进性肾炎,2020/6/14,TheFirstHospitalofXinxiangMedicalCollege,16,HSPN的治疗免疫抑制剂CTX,2-3mg/kg.d口服或静注CTX冲击10mg/kg.dX2dX4-5次后每3月1次,2020/6/14,TheFirstHospitalofXinxiangMedicalCollege,17,HSPN的治疗免疫抑制剂硫唑嘌呤,2-3mg/kg.d6-12月疗程注：也有人说3个月,2020/6/14,TheFirstHospitalofXinxiangMedicalCollege,18,HSPN的治疗免疫抑制剂,MMF2.0/d半年1.5/d半年1.0/d1年LEF50mgX3d20mg维持,2020/6/14,TheFirstHospitalofXinxiangMedicalCollege,19,HSPN的治疗,血小板抑制剂抗凝剂抗氧化剂ACEIandARB,2020/6/14,TheFirstHospitalofXinxiangMedicalCollege,20,HSPN的治疗,IVIG血浆置换间歇白细胞去除法自体或异体光量子血疗法,2020/6/14,TheFirstHospitalofXinxiangMedicalColl