环孢霉素A治疗狼疮性肾炎的临床研究

Clinical study of cyclosporine A (CyA) in treating lupus nephritis

本文前瞻性地对12例常规剂量激素治疗无效的狼疮性肾炎患者,用小剂量环孢霉素 A(CyA)(2.5～5 mg·kg^(-1)/d)与强的松联合治疗的临床及实验室变化进行了系统观察,并对外周血及肾组织内 CD4_4^+/CD_8^+淋巴细胞亚群作了系列测定。经平均3个月的治疗,半数患者达临床缓解,血尿消失,蛋白尿减轻,并伴有自身抗体滴度下降及补体升高;病变活动指数降低,强的松用量也减少;CD_4^+CD_8^+比值治疗后下降。对 CyA 治疗反应良好者,治疗前外周血CD_4^+细胞相对较高,而 HLA-DR^+细胞及冷球蛋白则偏低。本疗法的副作用以胃肠不适、血压增高较常见,经对症处理或减少 CyA 用量后均可得到控制。

Twelve patients with lupus nephritis(LN),were treated with CyA and low dose prednisone(Pred)for refractory nephrotic syndro- me.Clinical laboratory investigations and lymphocyte subsets in peripheral blood and kidney were followed,After mean period of 3 months on CyA, 2.5-5 mg/kg/day,there was a clinical remission in 6 cases.Activity index fell from 8.33±1.5 to 2.17±1.83 with disappearence of hematuria, less proteinuria,decreasing of anti-ds DNA antibody titers and CD_4^+/CD_8^+ ratio,and the complement levels increased.The effects on skin rash and thrombocytopenia were favoured.Pred dose was reduced from 35.4±17.2 to 14.2±9.2 mg/day.Compared with the non-responders to CyA,the responders showed relatively high number of peripheral CD_4^+ lymphocytes. The side effects included nausea,anorexia,hypertension,and serum creati- nine level increased in 3 cases which was back to normal with the reduc- tion of CyA dosage.While symptoms ameliorated the dosage of steroids was reduced with the induction of CyA.Side effects were mild of the abo- ve regime.It is concluded that CyA combined with low dose steroids is effective in treating LN.