重症狼疮肾炎的血浆分离吸附治疗  

Plasma adsorption treatment for severe lupus nephritis

作　　者：朱兴华[1] 罗伟雄[2] 陈璐[1] 丘宝珍 

机构地区：[1]梅州市人民医院血液净化中心,广东梅州514000 [2]梅州市人民医院重症医学一科,广东梅州514000

出　　处：《中国血液净化》2017年第2期113-116,共4页Chinese Journal of Blood Purification

基　　金：梅州市科委立项课题(项目编号:2014B91)

摘　　要：目的观察血浆分离吸附(plasma adsorption,PA)对重症狼疮肾炎(lupus nephritis,LN)患者的临床疗效。方法收集2011年1月~2015年12月在梅州市人民医院肾内科住院肾活检证实为重症LN患者80例。分为免疫抑制组和PA组。免疫抑制组予以激素联合免疫抑制剂治疗。PA组给予3次PA基础上,予以免疫抑制治疗。观察治疗前与治疗3周后患者生化指标、免疫指标、炎症因子、系统性红斑狼疮疾病活动指数(systemic lupus erythematosus disease activity index,SLEDAI评分)的变化。对比两组治疗的总有效率。结果 PA组治疗后患者血肌酐(t=0.377,P=0.021)、尿素氮(t=0.351,P=0.030)、24h尿蛋白(t=0.417,P=0.012)均较治疗前明显下降;血清Ig G(t=2.553,P<0.001)、红细胞沉降率(t=0.507,P=0.001)、C-反应蛋白(t=2.765,P<0.001)、SLEDAI评分(t=0.444,P=0.003)这些临床评估患者狼疮活动的指标均较前明显下降;并且血清白细胞介素-4(t=3.445,P<0.001)、白细胞介素-6(t=0.406,P=0.013)及肿瘤坏死因子-α(t=0.401,P=0.011)水平均较治疗前明显下降。PA组总有效率明显高于免疫抑制组(χ~2=23.667,P<0.001)。结论免疫抑制治疗联合PA能快速清除重症LN血清的抗体,减少狼疮活动,促进病情恢复,值得临床更广泛应用。Objective To observe plasma adsorption （PA） for the treatment of severe lupus nephritis. Methods A total of 80 severe lupus nephritis patients confirmed by renal biopsy in the Urology Department of Meizhou City People＇s Hospital from Jan. 2011 to Dec. 2015 were recruited. They were divided into PA group and immunosuppressive group. Patients in the immunosuppressive group were treated with glucocortocoid and immunosuppressives. Patients in the PA group were treated with PA and immunosuppressives. Biochemical indicators, immune indices, inflammatory factors, and systemic lupus erythematosus disease activity index （SLEDAI score） were observed and compared before and after the treatment for 3 weeks. Results After PA, patients serum creatinine （t=0.377, P=0.021）, blood urea nitrogen （t=-0.351, P=-0.030）, and 24 hours urinary protein （t=0.417,P=-0.012） decreased significantly. Serum IgG （t=2.553, P〈0.001）, erythrocyte sedimentation rate （t=0.507, P=-0.001）, C-reactive protein （t=-2.765, P〈0.001）, and SLEDAI score （t=0.444, P=0.003） decreased significantly, as compared those before PA. Serum interleukin 4 （IL-4） （t=-3.445, P〈0.001）, interleukin 6 （IL-6） （t=0.406, P=0.013） and tumor necrosis factor-α（TNF- α） （t=-0.401, P=-0.011） also decreased significantly. The overall effective rate in PA group was significantly higher than that of immunosuppressive group （X2=23.667, P〈0.001）. Conclusion Immunosuppressives combined with PA can quickly reduce serum antibodies and systemic lupus erythematosus disease activity, and acclerate the recovery from systemic lupus erythematosus. We recommend the use of PA for severe lupus nephritis patients.

关 键 词：重症狼疮肾炎 血浆分离吸附 免疫抑制治疗 SLEDAI评分 

分 类 号：R459.5[医药卫生—治疗学]