免疫吸附联合糖皮质激素和环磷酰胺治疗重症系统性红斑狼疮的临床观察  

Short-term effectiveness of immunoadsorption in combination with small dose of glucocorticoids and cyclophosphamide in treating severe systemic lupus erythematosus

作　　者：宁军[1] 许雪芳[1] 黄卫华[1] 黄乙江[1] 张河[1] 许宁本[1] 刘莹莹[1] 

机构地区：[1]广西壮族自治区钦州市第一人民医院肾内科,535000

出　　处：《临床肾脏病杂志》2012年第2期72-74,共3页Journal Of Clinical Nephrology

摘　　要：目的探讨免疫吸附联合小剂量糖皮质激素和环磷酰胺（CTX）治疗重症系统性红斑狼疮（SLE）的近期疗效和安全性。方法选择我院36例重症SLE患者。对照组18例，予传统糖皮质激素和CTX治疗组18例，予免疫吸附联合小剂量糖皮质激素和CTX。治疗前后检测抗核抗体（ANA），抗双链DNA（ds—DNA）抗体和免疫球蛋白、补体、SLE疾病活动性指数（SLEDAI）评分等指标，观察临床症状和体征，尿蛋白、血常规、肾功能、肝功能的影响及不良反应。结果治疗12w后两组患者症状和体征均改善。ANA、抗ds-DNA抗体、免疫球蛋白IgG和SLEDAI评分明显下降，以治疗组更显著（P〈0．05）；尿蛋白和肾功能明显好转，以治疗组更显著，但差异无统计学意义。治疗组感染、精神异常和心律失常等不良反应发生较少。随访9个月，两组免疫学指标及肾功能均稳定。血常规、补体、肝功能无明显影响。结论免疫吸附联合小剂量糖皮质激素和CTX治疗重症SLE，能迅速控制红斑狼疮活动，缓解症状及控制病情，近期疗效不低于或相当于传统的糖皮质激素和CTX治疗，安全性较好，可推荐于大剂量激素应用存在较大风险或相对禁忌的重症SLE治疗。Objective To explore the clinical effects and safety of immunoadsorption in combination with small dose of glucocortieoids and cyclophosphamide （CTX） in the treatment of severe systemic lupus erythematosus （SLE）. Methods A retrospective analysis was performed on 36 cases of severe SLE. The patients in control group were subjected to traditional glucocorticoids and CTX, and those in treatment group to immunoadsorption in combination with small dose of glucocorticoids and CTX. The titers of ANA and ds DNA antibody, complement and SLEDAI scores were measured before and after treatment. The clinical signs and symptoms, urinary protein, blood routine, renal function and hepatic function were observed. Resuits After treatment for 12 weeks, patients showed significantly clinical improvement especially in the treatment group. There were significant changes in autoantibodies （ANA and anti-dsDNA）, IgG and SLEDM scores. There was significant difference between treatment group and control group （P〈0. 05）. Urinary protein and renal function improved greatly, but there was no significant difference between two groups （P〈0. 05）. Treatment group showed fewer adverse drug reactions, such as infection, arrhythmia and psychiatric disorders. During a follow-up period of 9 months, all of the patients had steady immunology index and renal function. Blood routine, complement and hepatic function were not affected markedly. Conclusions Immunoadsorption in combination with small dose of glucocorticoids and CTX in treating SLE can effectively monitor disease activity, alleviate the symptoms and control the illness. The shortterm effect is not lower or equal to the traditional treatment. And it shows great efficacy and safety. It is recommended to treat high risk and severe SLE with high dose of glucocorticoids.

关 键 词：红斑狼疮 系统性 免疫吸附技术 糖皮质激素类 环磷酰胺 

分 类 号：R593.241[医药卫生—内科学]