双重血浆置换治疗重症狼疮性肾炎合并急性肾损伤的效果及安全性研究

The efficacy and safety of double plasma exchange in the treatment of severe lupus nephritis with acute renal injury

目的 探讨双重血浆置换治疗重症狼疮性肾炎(LN)合并急性肾损伤的效果及安全性。方法 选取2017年1月—2021年6月广西百色市人民医院风湿免疫科收治的重症LN合并急性肾损伤患者60例作为研究对象,按随机数字表法分为对照组和观察组,每组30例。2组均给予常规综合治疗,在此基础上对照组给予免疫制剂霉酚酸酯治疗,观察组给予免疫制剂霉酚酸酯联合双重血浆置换。比较治疗前、治疗2周后2组系统性红斑狼疮疾病活动指数(SLEDAI)、红细胞沉降率(ESR)、免疫学指标[抗双链DNA(ds-DNA)、抗核抗体(ANA)滴度、补体C3、补体C4]、肾功能[血清尿素氮(BUN)、血肌酐(SCr)、24 h尿蛋白、尿红细胞]、凝血功能[血小板、纤维蛋白原(Fib)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)]、炎性指标[白介素6(IL-6)、C反应蛋白(CRP)、肿瘤坏死因子α(TNF-α)、IL-1],评价临床疗效并观察不良反应发生情况。结果 观察组总缓解率与对照组比较,差异无统计学意义(96.67%vs.80.00%,P>0.05)。治疗2周后,观察组SLEDAI评分、ESR低于对照组(t/P=5.214/<0.001、3.989/<0.001);ds-DNA、抗ANA滴度低于对照组(t/P=7.102/<0.001、4.857/<0.001),补体C3、C4显著高于对照组(t/P=3.657/<0.001、4.102/<0.001);SCr、BUN、24 h尿蛋白、尿红细胞均低于对照组(t/P=6.213/<0.001、5.039/<0.001、3.574/<0.001、4.321/<0.001);Fib低于对照组(t/P=3.345/0.001),PT、APTT高于对照组(t/P=2.635/0.011、2.201/0.032);血清IL-6、CRP、TNF-α、IL-1均低于对照组(t/P=4.717/<0.001、4.305/<0.001、2.202/0.032、6.015/<0.001)。2组不良反应发生率比较差异无统计学意义(P>0.05)。结论 双重血浆置换治疗LN合并急性肾损伤患者疗效确切,在肾功能、免疫功能、炎性反应、凝血功能等方面具有显著效果,且未明显增加患者不良反应,安全性较好。

Objective To investigate the efficacy and safety of double plasma exchange in the treatment of severe lupus nephritis(LN) with acute renal injury. Methods From January 2017 to June 2021, 60 patients with severe LN combined with acute renal injury admitted by the Rheumatology and Immunization Department of Guangxi Baise People’s Hospital were selected as the research objects, and were divided into the control group and the observation group according to the random number table method, with 30 cases in each group. Both groups were given conventional comprehensive treatment. On this basis, the control group was given immune preparation mycophenolate mofetil, and the observation group was given immune preparation mycophenolate mofetil combined with double plasma exchange. The disease activity index(SLEDAI), erythrocyte sedimentation rate(ESR), immunological indexes(anti double stranded DNA(ds-DNA), antinuclear antibody(ANA) titer, complement C3, complement C4), renal function(serum urea nitrogen(BUN), serum creatinine(SCr), 24h urine protein, urine red blood cell), coagulation function [platelet, fibrinogen(Fib), prothrombin time(PT) Activated partial thromboplastin time(APTT)], inflammatory indicators [interleukin-6(IL-6), C-reactive protein(CRP), tumor necrosis factor-α(TNF-α), IL-1], evaluate the clinical efficacy and observe the occurrence of adverse reactions.Results There was no significant difference in the total remission rate between the observation group and the control group(96.67% vs.80.00%, P>0.05). After 2 weeks of treatment, SLEDAI score and ESR in the observation group were lower than those in the control group(t/P=5.214/< 0.001, 3.989/< 0.001). The titers of ds DNA and anti-ANA were lower than those in the control group(t/P=7.102/< 0.001, 4.857/< 0.001), while the complement C3 and C4 were higher than those in the control group(t/P=3.657/< 0.001, 4.102/< 0.001). SCr, BUN, 24h urine protein and urinary red blood cells were lower than those in the control group(t/P=6.213/< 0.001, 5.039/< 0.001, 3.574/< 0.001, 4.321/< 0.001). Fib was lower than the control group(t/P=3.345/0.001), PT and APTT were higher than the control group(t/P=2.635/0.011, 2.201/0.032). Serum IL-6, CRP, TNF-α, IL-1 in the control group was lower than that in the control group(t/P=4.717/< 0.001, 4.305/< 0.001, 2.202/0.032, 6.015/< 0.001). There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion Hemodialysis combined with double plasma exchange in the treatment of LN patients with acute kidney injury has significant effects in renal function, immunity, inflammation, coagulation function, and this regimen will not significantly increase the adverse reactions of patients, which can ensure the safety during treatment.