应用免疫吸附治疗重症系统性红斑狼疮的疗效观察  

Effects of immunoadsorption in severe systemic lupus erythematosus

作　　者：姚国乾[1] 韩志武[1] 肖琼[1] 李靖[1] 徐友平[1] 沈俊[1] 

机构地区：[1]中国人民解放军第一六一医院肾内科,武汉430010

出　　处：《肾脏病与透析肾移植杂志》2008年第6期507-511,共5页Chinese Journal of Nephrology,Dialysis & Transplantation

摘　　要：目的:探讨葡萄球菌蛋白A免疫吸附(immunoadsorption,IA)治疗重症系统性红斑狼疮(SLE)的效果及临床应用价值。方法:收集重症SLE患者67例,均合并重要器官受损,SLEDAI评分≥12分,SLE发作类型为严重/大发作。在原有常规激素及其他免疫抑制剂治疗的基础上,加用葡萄球菌A蛋白免疫吸附治疗,观察治疗前后免疫球蛋白、补体水平、自身抗体(ANA、Anti-dsDNA、Anti-Sm)、SLEDAI评分及重要器官损害的变化。通过前后对照分析,评价IA治疗重症SLE的疗效。结果:经IA治疗后,血IgG水平由(21.98±4.43)g/L降为(5.28±1.37)g/L,IgA由(2.16±0.25)g/L降为(1.07±0.25)g/L,IgM由(1.82±0.30)g/L降为(0.91±0.21)g/L(均为P<0.01),C3、C4在治疗前后无显著变化。ANA阳性率由100%降至8.96%,Anti-dsDNA阳性率由100%降至4.48%,Anti-Sm阳性率由29.85%降至5.97%(均为P<0.01)。IA后SLEDAI由22.70±6.43降至5.52±4.68(P<0.01)。IA后12周,67例患者中52例缓解,12例部分缓解,总缓解率95.5%。结论:A蛋白免疫吸附可有效清除自身抗体、控制狼疮活动,对重症SLE活动,采用A蛋白免疫吸附配合常规激素和免疫抑制剂治疗,可提高疗效。Objective ： To explore the effects and clinical value of staphylococcal protein A immunoadsorption （ immunoadsorption, IA） for treatment of severe systemic lupus erythematosus （SLE）. Methodology：Sixty seven cases of severe SLE patients with the damage of vital organs, SLEDAI score ≥ 12 points, and serious/severe type of SLE attack were collected in this retropective study. On the base of conventional steroid and immunosuppressive agents therapy, IA was applied for all of patients. The levels of serum immunoglobulins, complements and autoantibodies （ ANA, Anti-dsDNA, Anti-Sm）, SLEDAI score and the vital organs such as liver and kidney-related changes in clinical symptoms were obsered for 12 weeks. Results：After IA treatment, the plasma level of IgG was significantly decreased from （21.9 ±4.43 ） g/L to （5.28±1.37 ） g/L, IgA from （2. 16± 0. 25 ） g/L to （ 1.07±0. 25 ） g/L, and IgM from （ 1.82± 0. 30） g/L to （0. 91±0. 21 ） g/L （P 〈0. 01 ）. The autoantibody positive rate of ANA was from 100% to 8.96%, Anti-dsDNA from 100% to 4. 48% , and Anti-Sm from 29. 8% to 5.97% （P 〈0. 01 ）. However, the levels of C3 and C4 were no signifcant changes before and after treatment. After 12 weeks of sequential observation, patients with SLEDAI score was significantly declined from 22. 7 ± 6. 43 to 5.52 ±4. 68 （ P 〈 0. 01 ）, the general conditions were markedly improved, and the important organs dysfunction was ameliorated or recovery. 52 cases were complete remission, 12 cases partial remission, three cases invalid, and the totall remission rate was achieved 95.5%. And the efficacy remained stable in the observation period and the subsequent follow-up period of 1 year. Conclusion：Protein A immunoadsorption technology can effectively cleared autoantibodies, control lupus activity of severe SLE activity, using protein A immunoadsorption combined with conventional steroid therapy and immunosuppressive agents may enhance the effectiveness of treatment.

关 键 词：系统性红斑狼疮 葡萄球菌蛋白A 免疫吸附 临床疗效 

分 类 号：R593.241[医药卫生—内科学] R746.105[医药卫生—临床医学]