免疫净化联合小剂量环磷酰胺冲击治疗系统性红斑狼疮的临床对照研究

Efficacy of low-dose intravenous cyclophosphamide in combination with immunoclearance in treatment of systemic lupus erythematosus

目的了解免疫净化联合小剂量环磷酰胺(CTX)冲击治疗系统性红斑狼疮(SLE)的疗效。方法回顾性分析北京大学人民医院SLE患者61例,其中28例给予免疫净化联合小剂量CTX冲击治疗,33例应用小剂量CTX冲击治疗,疗程1年。CTX每2周1次,每次400mg,连续3～6个月,之后每月1次,1次400mg;联合治疗组在给予CTX前均行免疫净化1～3次,2组患者均给予常规量糖皮质激素,疗程均为1年。监测患者症状,定期检测血常规、24h尿蛋白定量、血肌酐、白蛋白、免疫球蛋白、C3、C4、ANA、抗ENA抗体及抗dsDNA抗体水平。比较治疗前和治疗后1年不同组各项指标的变化。结果小剂量CTX冲击治疗1年后患者SLEDAI评分由治疗前平均13.73分降至平均5.44分;免疫净化联合小剂量CTX冲击治疗1年后患者SLEDAI评分由治疗前平均14.37分降至平均5.17分,2组统计学差异均有显著性。另外,治疗1年后小剂量CTX组和免疫净化联合小剂量CTX冲击治疗组抗ENA抗体分别转阴18.2%和42.9%,抗dsDNA抗体分别转阴39.4%和85.7%,2组统计学差异均有显著性。结论免疫净化联合小剂量CTX冲击治疗SLE的疗效优于小剂量CTX冲击治疗,且起效快,复发率低。

Objective To investigate the efficacy of low-dose intravenous cyclophosphamide （IV CTX） in combination with immunoclearance in treatment of systemic lupus erythematosus. MethedsSixty one SLE patients were analysed. Patients assigned to the low-dose group（33 cases） received 6 to 12 fortnightly IV CTX pulses at a fixed dose of 400mg followed by 6 monthly pulses. Patients assigned to the low-dose IV CTX in combination with immunoclearance received 1 to 3 times of immunoclearance before the treatment of CTX. All patients received the treatment of glucocorticosteroid. The changes of the indexes were observed before and after one year treatment including the symptoms and the levels of WBC, PLT, Hb, serum creatinine, albumin, C3, C4, 24-hour urinary protein, IgG, IgA, IgM, kNA, anti-dsDNA antibody and anti-ENA antibody. Results After a median followup of 1 year, the SLEDAI decreased from 13.73 to 5.44 in the lowdose IV CTX group and from 14.37 to 5.17 in those who received the low-dose IV CTX in combination with immunoclearance. Otherwise seroconversion rate of anti-ENA antibody were 18.2% and 42. 9% in the low-dose IV CTX group and the low-dose Ⅳ CTX in combination with immunoclearance group. The seroconrersion rate of anti-dsDNA antibody were 39.4% and 85.7% in the low-dose Ⅳ CTX group and the low-dose IV CYC in combination with immunoclearance group. There were statistical difference between the two groups. ConclusionThe efficacy of low-dose IV CTX in combination with immunoclearance in treatment of SLE achieves significant results than those obtained by low-dose IV CTX regimen.