脐带间充质干细胞移植治疗难治性狼疮性肾炎的远期预后分析  

Long-term prognosis analysis of umbilical cord mesenchymal stem cell transplantation in treating refractory lupus nephritis

作　　者：鲍星兰 王丹丹 靳子义[2] 贾婕婷 孙凌云 BAO Xinglan;WANG Dandan;JIN Ziyi;JIA Jieting;SUN Lingyun(Drum Tower Clinical Medical College of Nanjing Medical University,Nanjing,Jiangsu,210008;Department of Rheumatology,Drum Tower Hospital Affiliated to School of Medicine of Nanjing University,Nanjing,Jiangsu,210008)

机构地区：[1]南京医科大学鼓楼临床医学院,江苏南京210008 [2]南京大学医学院附属鼓楼医院风湿科,江苏南京210008

出　　处：《实用临床医药杂志》2023年第10期1-5,20,共6页Journal of Clinical Medicine in Practice

基　　金：国家自然科学基金(81930043)。

摘　　要：目的探讨脐带间充质干细胞(UC-MSC)移植治疗难治性狼疮性肾炎(LN)的疗效及远期预后。方法选取接受UC-MSC治疗的92例难治性LN患者为研究对象。采用t检验、Mann-Whitney U检验、卡方检验、Kaplan-Meier等统计学方法进行数据分析。根据3年随访结果,将获得持续肾脏缓解的患者纳入有效组(n=45),47例未缓解或复发的患者纳入无效组(n=47)。比较2组患者一般情况及实验室检查结果。结果92例难治性LN患者随访3年,共45例患者获得持续肾脏缓解,总缓解率(完全缓解率和部分缓解率)为48.9%(45/92),其中完全缓解率为6.5%(6/92),部分缓解率为42.4%(39/92);37例患者未缓解,10例患者缓解后复发。17例患者发生终点事件(死亡4例、维持透析13例),终点事件发生率为18.5%(17/92),共4例患者死亡,总生存率为95.7%(88/92)。有效组和无效组患者基线血肌酐(SCr)、肾小球滤过率(eGFR)、英国狼疮评定组(BILAG)肾脏评分比较,差异有统计学意义(P<0.05)。COX多因素回归分析显示,基线eGFR水平是预后的影响因素(P<0.05)。结论UC-MSC治疗难治性LN具有良好的疗效及远期预后,其中基线eGFR水平低是影响疗效的危险因素。Objective To investigate the efficacy and long-term prognosis of umbilical cord derived mesenchymal stem cells(UC-MSC)transplantation in treatment of refractory lupus nephritis(LN).Methods Ninety-two patients with refractory LN treated with UC-MSC were selected as subjects.Statistical methods such as t test,Mann-Whitney U test,Chi-square test and Kaplan-Meier were used for data analysis.Patients who achieved sustained renal response were included in the effective group(n=45)and those who had no response or relapse were included in the ineffective group(n=47)based on results of 3-year follow-up.The general condition and laboratory test results were compared between the two groups.Results The 92 patients with refractory LN were followed up for 3 years,and 45 patients achieved sustained renal response.The overall response rate(complete response rate and partial response rate)was 48.9%(45/92),with complete response rate of 6.5%(6/92)and partial response rate of 42.4%(39/92);thirty-seven patients had no remission and 10 relapsed after remission.Endpoint events occurred in 17 patients(4 died and 13 remained dialysis),and the incidence of endpoint events was 18.5%(17/92);a total of 4 patients died,and theoverall survival rate was 95.7%(88/92).There were significant differences in baseline serum creatinine(SCr),glomerular filtration rate(eGFR)and kidney score in Lupus Assessment UK group(BILAG)between effective and ineffective groups.COX multivariate regression analysis showed that baseline eGFR level was a prognostic factor(P<0.05).Conclusion UC-MSC in treatment of refractory LN has good efficacy and long-term prognosis,and low baseline eGFR level is a risk factor affecting the efficacy.

关 键 词：难治性狼疮性肾炎 间充质干细胞 肾脏缓解 远期预后 肾小球滤过率 系统性红斑狼疮 

分 类 号：R593.24[医药卫生—内科学] Q81[医药卫生—临床医学]