激素联合霉酚酸酯和他克莫司治疗狼疮性肾炎疗效及对患者血清IL-6、IL-13、IL-18水平的影响

Effect of hormone combined with mycophenolate mofetil and tacrolimus in treatment of lupus nephritis and effect on serum levels of IL-6,IL-13 and IL-18

目的探讨激素联合霉酚酸酯(MMF)和他克莫司治疗狼疮性肾炎(LN)的疗效及对患者血清白细胞介素-6(interleukin 6,IL-6)、IL-13、IL-18水平的影响。方法选取2016年11月~2019年3月收治的58例LN患者,按随机数字表分为两组,各29例。研究组采用激素联合MMF及他克莫司,对照组采用激素联合环磷酰胺(CTX)。统计两组治疗效果、不良反应,分析入院时及疗程结束时两组血清白细胞介素(IL-6、IL-13、IL-18)、辅助性T细胞1(Th1)、Th2、Th1/Th2与免疫功能指标(IgA、IgG)水平变化情况。结果(1)治疗效果:研究组治疗总有效率93.10%(27/29)高于对照组68.97%(20/29),差异有统计学意义(P<0.05);(2)血清白细胞介素:两组IL-6、IL-13、IL-18水平治疗后较治疗前降低,且研究组低于对照组,差异有统计学意义(P<0.001);(3)Th1、Th2、Th1/Th2水平:治疗前两组Th1、Th2、Th1/Th2水平比较,差异无统计学意义(P>0.05),治疗后研究组Th2水平较对照组低,Th1、Th1/Th2水平较对照组高(P<0.001);(4)免疫功能:治疗前两组IgA、IgG水平比较差异无统计学意义(P>0.05),治疗后研究组IgA、IgG水平低于对照组(P<0.001);(5)不良反应:不良反应发生率研究组17.24%(5/29)与对照组24.14%(7/29)比较,差异无统计学意义(P>0.05)。结论激素联合霉酚酸酯和他克莫司治疗狼疮性肾炎可改善患者免疫功能,下调IL-6、IL-13及IL-18表达,具有安全性。

Objective To investigate the effect of hormone combined with mycophenolate mofetil(MMF)and tacrolimus in the treatment of lupus nephritis(LN)and the effect on serum levels of serum interleukin-6(IL-6),IL-13 and IL-18 levels.Methods From November 2016 to March 2019,58 patients with LN admitted to our hospital were selected and divided into two groups by random number table,with 29 patients in each group.Study group were treated with hormone combined with MMF and tacrolimus,while control group were treated with hormone combined with cyclophosphamide(CTX).The therapeutic effects and adverse reactions of the two groups were counted.The changes of serum interleukin(IL-6,IL-13,IL-18),T helper 1 cells(Th1),Th2,Th1/Th2 and immune function indexes(IgA,IgG)levels in the two groups were analyzed at admission and at the end of treatment.Results(1)Treatment effect:the effective rate of the study group was 93.10%(27/29),higher than that of the control group(68.97%,20/29),and difference was statistically significant(P<0.05).(2)Serum interleukin:after treatment,the levels of IL-6,IL-13 and IL-18 in the two groups were lower than those before treatment,and those in the study group were lower than those in the control group,with statistical significance(P<0.05).(3)Levels of Th1,Th2 and Th1/Th2:there was no statistically significant difference in the levels of Th1,Th2 and Th1/Th2 between the two groups before treatment(P>0.05),after treatment,the level of Th2 in the study group were lower than that in the control group,and the levels of Th1 and Th1/Th2 were higher than those in the control group(P<0.001).(4)Immune function:there was no statistically significant difference in IgA and IgG levels between the two groups before treatment(P>0.05),and the IgA and IgG levels in the study group were lower than those in the control group after treatment(P<0.001).(5)Adverse reactions:the incidence of adverse reactions was 17.24%(5/29)in the study group,compared with that in the control group(24.14%,7/29),the difference was not statistically significant(P>0.05).Conclusion Hormones combined with mycophenolate mofetil and tacrolimus in the treatment of lupus nephritis can improve the immune functions of patients,down-regulate the expressions of IL-6,IL-13 and IL-18,which is safe.