血浆置换联合小剂量环磷酰胺、糖皮质激素治疗重型系统性红斑狼疮的临床效果  

Efficacy of plasma exchange combined with small dose of cyclophosphamide and glucocorticoid in the treatment of severe systemic lupus erythematosus

作　　者：霍爱鑫 李静[1] 刘宇宏[1] 高鹏[1] HUO Ai-xin;LI Jing;LIU Yu-hong;GAO Peng(Department of Rheumatology, Affiliated Hospital of Yan'an University ,Yan'an 716000 , China)

机构地区：[1]延安大学附属医院免疫风湿病科,陕西延安716000

出　　处：《延安大学学报（医学科学版）》2018年第4期14-17,共4页Journal of Yan'an University:Medical Science Edition

摘　　要：目的探讨血浆置换联合小剂量环磷酰胺(CTX)、糖皮质激素治疗重型系统性红斑狼疮(SLE)的疗效。方法选取2015-01-01～2018-03-31在延安大学附属医院住院治疗的67例重型SLE患者,并将其随机分为研究组(33人)和对照组(34人),研究组治疗方案:糖皮质激素+血浆置换+环磷酰胺(诱导期:CTX 400 mg,静滴,每2周一次,共6次;维持期:CTX 400 mg,静滴,每月一次,两期共8. 0 g)。对照组治疗方案:糖皮质激素+CTX(诱导期:CTX 800 mg,静滴,每5天1次,共6次,维持期:CTX 800 mg每3月一次,两期总量共8. 0 g)。比较两组患者治疗前后狼疮疾病活动指数(SLEDAI)、补体C4、抗ds DNA抗体、红细胞沉降率(ESR)、C反应蛋白(CRP)的变化、及临床症状的改善情况。结果治疗后研究组临床改善率要高于对照组,差异有统计学意义(P <0. 05);治疗后1月、3月、1年,研究组患者的SLEDAI、补体C4、抗ds DNA抗体、ESR、CRP较对照组下降更明显,差异有统计学意义(P <0. 05);研究组发生副作用的人数为7人(21. 2%),对照组发生副作用的人数为18人(52. 9%),差异有统计学意义(P <0. 05),对照组的副作用发生率要高于研究组。结论血浆置换联合小剂量CTX、糖皮质激素治疗重型SLE的临床效果显著,值得进一步临床推广使用。Objective To explore the efficacy of plasma exchange combined with small dose of cyclophosphamide(CTX)and glucocorticoid in the treatment of severe systemic lupus erythematosus(SLE).Methods67cases of severe SLE patients were randomly divided into observation group(33cases)and control group(34cases)from January2015to March2018,in affiliated hospital of Yan'an university.Patients in the observation group was given low dose CTX and glucocorticoid treatment based on the use of plasma exchange(induction period:400mg CTX for every two weeks,a total of six times;maintenance period:CTX400mg intravenous drip once a month,a total of8.0g in two phases).Patients in the control group was given CTX and glucocorticoid treatment(induction period:800mg CTX for every five days,a total of six times;maintenance period:CTX400mg intravenous drip once every three months,a total of8.0g in two phases).SLEDAI,C4,dsDNA antibody,ESR,CRP,and the improvement of clinical symptoms were compared before and after treatment.Results The clinical improvement rate of the study group was higher than that of the control group after treatment,and the difference was statistically significant(P<0.05).After1month,3months,and1year after treatment,the SLEDAI,complement C4,anti-dsDNA antibody,ESR,and CRP in the study group were significantly lower than those in the control group,and the difference was statistically significant(P<0.05).The number of side effects in the study group was7(21.2%),and the number of side effects in the control group was18(52.9%).The difference was statistically significant(P<0.05).The incidence of side effects in the control group was higher than that in the study group.Conclusion The clinical effect of plasma exchange combined with low-dose CTX and glucocorticoid on severe SLE is significant and worthy of further clinical application.

关 键 词：血浆置换 甲氨蝶呤 糖皮质激素 系统性红斑狼疮 环磷酰胺 

分 类 号：R593.241[医药卫生—内科学]