血管炎怎样治疗

血管炎如何治疗配图，仅供参考

Treatment of systemic vasculitis
Standard therapy for systemic vasculitis is initiated with high doses of oral corticosteroids (1–1.5 mg/kg/day up to 80 mg). When remission is achieved,decrease must be slow and progressive,in order to obtain a daily dose of prednisone in the range of 20 mg/day at three months,10 mg/day at six months,and 5 mg/day at 12 months,until withdrawal between 12 and 24 months. Thus,as in CSVV,in severe or recurrent forms,corticosteroids should always be associated with immunosuppressive therapy. Cyclophosphamide may be administered orally (500 mg/day to 2 g/kg/day) or intravenously (600 mg/m2,every two to four weeks),which is generally preferred as it presents comparable efficacy with a lower rate of side effects. Once remission is achieved (three to six months),a switch to a maintenance regimen with methotrexate (15–25 mg/week),azathioprine (2 mg/kg/day),or cyclosporine (2.5–5.0 mg/kg/day administered orally,divided into two doses) is recommended in order to avoid possible complications of cyclophosphamide therapy. Oral or parenteral methotrexate can be used as a less toxic alternative to cyclophosphamide to induce remission in non-life-threatening AAVs or in cases without target organ damage. Mycophenolate mofetil (2 g/day orally) or leflunomide are used in patients who are intolerant or unresponsive to methotrexate or azathioprine.,Treatment options for refractory cases include the anti-CD20 monoclonal antibody rituximab (500 mg every six months for 18 months) and TNF-α inhibitors (infliximab or etanercept),as well as intravenous immunoglobulin (200–1000 mg/kg/day). TNF-α inhibitors are useful in inducing remission of ADA2 deficiency,while other immunosuppressants did not achieve the expected results. Maintenance therapy for systemic vasculitis should be continued for 18–24 months after remission,due to the high frequency of relapses. In patients with PAN associated with HBV,conventional treatment regimens without antiviral therapy are contraindicated due to the risk of continuous viremia,progression of chronic hepatitis or cirrhosis and,more alarmingly,reactivation of the virus with fulminant hepatitis. Thus,a combination of corticosteroids,plasmapheresis,and antiviral therapy is recommended. Plasmapheresis is also used for patients with rapidly progressive severe kidney disease,in order to improve survival; in this scenario,it has proven to be superior to methylprednisolone pulses (1 g/day for three days). The treatment of the vasculitis described in this study is summarized in [table 5](https://ncbi.nlm.nih.gov/pmc/articles/PMC7335877/table/tbl0025/) . The posology of the listed drugs considers the dose for adult patients.","department":"