环磷酰胺联合泼尼松治疗对狼疮性肾炎患者免疫功能及血清类风湿因子、C反应蛋白及白介素-17水平的影响  

Effects of cyclophosphamide combined with prednisone on immune function,serum rheumatoid factors,C reaction protein and interleukin-17 in patients with lupus nephritis

作　　者：陈士军[1] 张晓艳 罗田 王凯 CHEN Shijun;ZHANG Xiaoyan;LUO Tian;WANG Kai(Ankang Central Hospital, Ankang, Shaanxi, 725000)

机构地区：[1]陕西省安康市中心医院

出　　处：《实用临床医药杂志》2019年第15期75-78,82,共5页Journal of Clinical Medicine in Practice

基　　金：陕西省科学技术研究发展计划项目(2016G16-362-151)

摘　　要：目的探讨环磷酰胺联合泼尼松对狼疮性肾炎(LN)患者免疫功能及血清类风湿因子(RHF)、C反应蛋白(CRP)及白介素-17(IL-17)水平的影响.方法将90例LN患者随机分为对照组与观察组,每组45例.对照组单用泼尼松治疗,观察组在对照组基础上加用环磷酰胺治疗.比较2组治疗效果,比较2组治疗前后免疫功能[免疫球蛋白A(IgA)、免疫球蛋白G(IgG)、免疫球蛋白M(IgM)、补体C3、补体C4]、肾功能[红细胞沉降率(ESR)、血清肌酐(Scr)、24h尿蛋白定量]及炎症因子(RHF、CRP及IL-17)的变化,比较2组不良反应发生率.结果观察组治疗总有效率显著高于对照组(P<0.05).疗程结束后,2组IgA、IgM、IgG、ESR、Scr、24h尿蛋白定量、RHF、CRP、IL-17显著降低,C3、C4显著上升(P<0.05),观察组疗程结束时IgA、IgM、IgG、ESR、Scr、24h尿蛋白定量、RHF、CRP、IL-17显著低于对照组,C3、C4显著高于对照组(P<0.05).2组不良反应发生率比较,差异无统计学意义(P>0.05).结论环磷酰胺联合泼尼松治疗LN疗效肯定,可改善患者免疫功能及肾功能,下调RHF、CRP、IL-17水平,且安全性较高.Objective To investigate the effects of cyclophosphamide combined with prednisone on immune function,serum rheumatoid factor(RHF),C reactive protein(CRP) and interleukin-17(IL-17) in patients with lupus nephritis(LN). Methods Totally 90 patients with LN were randomly divided into control group and observation group,with 45 cases in each group. The control group was treated with prednisone,and the observation group was treated with cyclophosphamide on the basis of control group. The efficiency was compared between the two groups. The changes of immune function [immunoglobulin A(IgA),immunoglobulin G(IgG),immunoglobulin M(IgM),complement C3,complement C4],renal function [erythrocyte sedimentation rate(ESR),serum creatinine(Scr),24-hour urinary protein quantification]and inflammatory factors(RHF,CRP and IL-17) before and after treatment were compared between the two groups. The incidence rate of adverse reactions was compared between the two groups. Results The total effective rate of the observation group was significantly higher than that of the control group(P < 0. 05). After treatment,levels of IgA,IgM,IgG,ESR,Scr,24-hour urinary protein quantification,RHF,CRP,IL-17 decreased significantly,and levels of C3 and C4 increased significantly in two groups(P < 0. 05). At the end of treatment,Ig A,Ig M,Ig G,ESR,Scr,24-hour urinary protein quantification,RHF,CRP,IL-17 in the observation group were significantly lower than those in the control group,while C3 and C4 were significantly higher than those in the control group(P < 0. 05). There was no significant difference in the incidence rate of adverse reactions between the two groups(P > 0. 05). Conclusion Cyclophosphamide combined with prednisone is effective and safe in treatment of LN,which can improve the immune function and renal function of patients,and reduce the levels of RHF,CRP and IL-17.

关 键 词：狼疮性肾炎 环磷酰胺 泼尼松 免疫功能 炎症因子 红细胞沉降率 血清肌酐 

分 类 号：R593.24[医药卫生—内科学]