免疫吸附在重症狼疮性肾炎患者中的应用  

The experience of plasma immune adsorption in patients with severe lupus nephritis

作　　者：潘丽萍[1] 杨尽梅[1] 韦颖[1] 石英萍[1] 张琼[1] 王晋文[1] 韦丽华[1] 朱昆生[1] 宋薇[1] 

机构地区：[1]云南省第二人民医院肾内科,昆明650021

出　　处：《肾脏病与透析肾移植杂志》2002年第6期514-518,共5页Chinese Journal of Nephrology,Dialysis & Transplantation

摘　　要：目的 :探讨免疫吸附 (IA)法治疗重症狼疮性肾炎 (LN)的临床疗效、达到缓解所需的次数、时间、安全性、联合免疫抑制剂的必要性。　 方法 :用特异性免疫吸附柱清除患者血浆中抗双链脱氧核糖核酸 (ds DNA)抗体及免疫复合物。本组 3 2例患者 ,12例为初治 ,2 0例为大剂量激素和联合间断环磷酰胺 (CTX)静脉冲击治疗无效或复发者。所有患者有明显血尿、管型尿、尿蛋白定量 >2 5g/ 2 4h ,有肾功能损伤 ,平均血肌酐 (42 4 2± 12 6 2 ) μmol/L ,血清抗ds DNA抗体、抗核抗体阳性 ,狼疮活动的LACC积分平均 (6 2 4± 1 46)分。经肾活检病理诊断为弥漫增生型(Ⅳ型 )LN。 3 2例患者均接受IA治疗 2～ 4次 ,平均 (3 0± 0 42 )次 ,同时口服小剂量强的松片 0 5mg/ (kg·d)及间断CTX静脉冲击 (总量 6～ 8g) ,随访半年以上。疗效判断为缓解、部分缓解、无效。　 结果 :3 2例患者随访 6个月内有 2 3例 (占 71 1% )获得缓解 ,7例 (占 2 2 2 % )部分缓解 ,2例无效。获得缓解的时间平均 (2 2± 0 76)个月。 6个月以后 ,有 4例复发 ,其中 3例因自行停用激素 ,1例因肺部感染诱发加重。　 结论 :IA联合中小剂量激素及间歇CTX冲击 ,能有效控制LN活动 。Objective:To investigate the clinical effects of plasma immunoadsorption(IA) in patients with severe lupus nephritis. Methodology:Thirty two patients with severe lupus nephritis,who treated by using system of specific IA colum for purifying double strands DNA (ds DNA) antibody and immune compounds in whole flood,were investigated in this study.12 cases were new patients,and 20 cases were no efficiency or recurrence who received the large dosage of steroid and cyclophosphamide(CTX)by the intravenous pulse therapy.All of patients were performed on renal biopsy and classified type Ⅳ of lupus nephritis in histologically.There were hematuria,cyclindeuria,urine protein(>2 5 g/24h),high level of serum creatinine(424 2±126 2)μmol/L,positive of A ds DNA antibody and antinuclear antibody,and lupus activity [LACC integra(6 24±1 46)]in clinically.They received the specific treatment of IA for twice to 4 times,associated with steroid (prednisolone 0 5 mg/kg·d -1 )and intermittently intravenous CTX pulse therapy(total dosage of 6 to 8 gram).The time of follow up was more than 6 months. Results:In follow up,23 patients(71 1%)were clinical remisson,7 patients(22 2%)partial remission,and 2 patients were inefficiency.The average time of clinical remission was (2 20±0 76) months.There were 4 cases with recurrence of symptoms after 6 months of follow up.The recurrent incidence was 12 5% in tour patients. Conclusion:The IA associated with steroid and cytotoxic agent is an effective and safe therapy in patients with severe lupus nephritis.The low recurrent rate of lupus nephritis in our cases may contribute to keep a few dosage of steroid after IA therapy.

关 键 词：应用 免疫吸附 狼疮性肾炎 免疫抑制剂 

分 类 号：R692.3[医药卫生—泌尿科学]