摘要
目的探讨免疫吸附联合小剂量环磷酰胺和糖皮质激素治疗重症系统性红斑狼疮(SLE)的临床疗效。方法选择16例重症SLE患者,应用免疫吸附联合小剂量环磷酰胺和糖皮质激素治疗,观察其治疗前后抗核抗体(ANA)、抗双链DNA抗体(ds-DNA抗体)和免疫球蛋白IgA、IgG、IgM的滴度变化,以及对补体C3、C4、血常规和肝肾功能的影响。结果免疫吸附后患者的症状和体征均明显改善,吸附治疗后ANA、ds-DNA抗体和免疫球蛋白IgG水平均显著下降(P<0.01),血清补体C3、C4和24 h尿蛋白吸附前后比较差异无统计学意义(P>0.05)。联合小剂量环磷酰胺和糖皮质激素治疗9个月,24 h尿蛋白由(3.48±3.25)g/24 h下降至(1.31±1.02)g/24 h,差异有统计学意义(P<0.01);1例患者ANA和ds-DNA抗体滴度再度升高,其余患者仍维持在较低水平。结论免疫吸附联合小剂量环磷酰胺和糖皮质激素治疗重症SLE,能在短时间内清除患者体内ANA和ds-DNA抗体,且较长时间维持较低水平,其临床疗效显著,安全性较好。
Objective To explore the clinical effects of immunoadsorption in combination with small dose of cyclophosphamide and glucocorticoids for treatment of severe systemic lupus erythematosus.Methods Sixteen cases of severe SLE patients were treated with immunoadsorption in combination with small dose of cyclophosphamide and glucocorticoids.The observation was focused on the changes of ANA and ds-DNA pre-treatment and after-treatment,titer variation of IgA,IgG and IgM antibody,the influence of the treatment on complements of C3 and C4,the routine blood test and liver ad kidney function.Results After immunoadsorption treatment,patients showed significantly clinical improvements;ANA,ds-DNA and the level of immunoglobulin IgG all had obvious decrease（P0.01）;There were no differences in the complements of C3 and C4 and 24-hour urinary protein before and after immunosorbent treatment（P0.05）.After the combination of small dose of cyclophosphamide and glucocorticoids for nine months,patients′ 24-hour urinary protein was significantly decreased from（3.48±3.25） g/24 h to（1.31±1.02） g/24 h.The combination treatment was significant（P0.01）.The increased titer of ANA and anti-dsDNA autoantibody was found in one patient,and no adverse reaction was found in the rest patients.Conclusion Immunoadsorption in combination with small dose of cyclophosphamide and glucocorticoids for treatment of SLE can effectively clear away patients′ ANA and anti-dsDNA autoantibody and help maintain the antibody level in a low level for a long time.The combination treatment turns out remarkable clinical efficacy as well as good safety.
出处
《中国全科医学》
CAS
CSCD
北大核心
2012年第15期1754-1756,共3页
Chinese General Practice
关键词
红斑狼疮
系统性
免疫吸附技术
环磷酰胺
糖皮质激素
Lupus erythematosus
systemic
Immunosorbent techniques
Cyclophosphamide
Glucocorticoids
