自体外周血干细胞移植联合ATG体内净化治疗系统性红斑狼疮  

Autologous Peripheral Blood Stem Cell Transplantation Combined with Intracorporeal Purge of Antithymocyte Globulin (ATG) for Systemic Lupus Erythematosus

作　　者：肖毅[1] 吴记平[1] 张义成[1] 张东华[1] 胡绍先[1] 徐祖森[1] 周剑峰[1] 孙汉英[1] 刘文励[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院,湖北武汉430030

出　　处：《医学临床研究》2008年第3期411-414,共4页Journal of Clinical Research

摘　　要：【目的】探讨自体外周血干细胞移植(APBSCT)联合抗胸腺淋巴细胞球蛋白(ATG)体内净化治疗系统性红斑狼疮(SLE)的初步疗效。【方法】对5例难治性SLE患者进行APBSCT同时联合使用ATG体内净化去除淋巴细胞。采用环磷酰胺(CTX)4g/m2化疗联合粒细胞集落刺激因子(G-CSF)5μg/(kg.d)动员患者的外周血干细胞,然后予CTX50mg/(kg.d)×4d预处理后回输保存的外周血干细胞,回输前予ATG(猪)20mg/(kg.d)×2d,回输中位单个核细胞(MNC)4.28×108/kg,中位CD34+细胞2.48×106/kg,回输后予ATG(猪)20mg/(kg.d)×2d行体内净化。移植后口服泼尼松5～10mg/d维持治疗。【结果】5例患者移植后造血均恢复顺利,中性粒细胞绝对计数(ANC)于中位时间+9d>0.5×109/L,血小板于中位时间+10d>20×109/L。干细胞动员过程中有3例患者出现疾病活动,加用泼尼松后控制。所有患者均于移植后1个月左右皮疹及关节疼痛逐渐消失,SIEDAI降至5分以下,尿蛋白减少或消失。移植后3个月复查自身抗体滴度下降。中位随访至移植后6.5个月,造血功能恢复良好,病情处于持续缓解状态。【结论】APBSCT联合ATG体内净化是治疗难治性SLE的有效方法之一,但要注意在移植过程中有感染和疾病活动的可能,长期疗效有待观察。[Objective]To explore the initial effect of autologous peripheral blood stem cell transplantation （APBSCT） combined with intracorporeal purge of antithymocyte globulin （ATG） for systemic lupus erythematosus （SLE）. [Methods] Five patients with refractory SLE received APBSCT combined with T-cell depletion by intracorporal purge of ATG. Mobilization regimen was cyclophosphamide （4 g/m^2） combined with G- CSF [5μg/（kg · d）]. The preconditioning regimen was CTX 50 mg/（kg · d） × 4 d and porcine ATG 20 mg/ （kg · d）×2 d. The median mononuclear cell （MNC） 4.28× 10^8/kg and CD34^＋ cell 2.48× 10^6/kg were infused, and porcine ATG 20 mg/（kg · d） × 2 d was infused for intracorporeal purge. All patients took orally prednisone 5-10mg/d after APBSCT. [Results]The hematopoietic stem cell was transplanted successfully. The median absolute neutrophil count （ANC） and platelet （PLT） were grafted respectively in ＋9d and ＋10d. Active lupus appeared in 3 patients during mobilization of stern cell, and it was controlled by increasing dosage of prednisone. The tetter and arthralgia of the patients were disappeared in 1 month after APBSCT, and SIEDAI score was decreased below 5. Proteinuria decreased or disappeared, and the autoantibodies decreased or became negative. The patients were followed up for 6.5 months after APBSCT, and the function of hemopoiesis was well. The state of illness retained continuous remission. [Conclusion] APBSCT combined with intracorporeal purge of ATG is effective for the treatment of refractory SLE, but infection and active lupus during APBSCT should be noticed, and the long-term effect should be followed up.

关 键 词：红斑狼疮 系统性/治疗 造血于细胞移植 

分 类 号：R593.241[医药卫生—内科学]