集中环磷酰胺冲击联合泼尼松在初治SLE患者中的疗效

Intensive pulse cyclophosphamide plus prednisone in newly diagnosed,untreated patients with systemic lupus erythematosus

目的:观察集中环磷酰胺(CTX)冲击联合泼尼松在初治系统性红斑狼疮(SLE)患者中的疗效。方法:选取初诊且未经治疗的SLE48例。CTX每2周冲击1次。每次第1dCTX0.4g,第2dCTX0.6g。泼尼松0.8mg/kg体质量。对SLE患者进行SLE活动性指数(SLEDAI)评分。将总分数(SLEDAIT)分成临床评分(SLEDAIc)、实验室评分(SLEDAIL)。分别于治疗前,治疗后4,8,12周进行SLEDAIT、SLEDAIc、SLEDAIL评分。于治疗前及治疗后12周测定尿蛋白、血清补体、血清抗双链DNA抗体(ds-DNA)。结果:共有41例随访至12周。治疗后4周与治疗前比较,SLEDAIT、SLEDAIc及SLEDAIL均明显下降(P<0.01),在8周时SLEDAIc继续下降(P<0.05),而SLEDAIL下降不明显。12周时SLEDAIT变化不明显。12周时与治疗前比较,补体C3、C4及ds-DNA均显著下(P<0.01)降,尿蛋白下降不明显。结论:集中环磷酰胺冲击方案有效。在12周时CTX总量可达6～8g,能迅速缓解病情,而不增加CTX的不良反应,可减少泼尼松的用量。

Objective： To assess the efficacy of intensive pulse cyclophosphamide （CTX） plus prednisone in newly diagnosed, untreated patients with systemic lupus erythematosus （SLE）. Methods： Forty-eight patients with newly diagnosed, untreated SLE were included. CTX was given intravenously once every 2 week, and the dose was 0.4 grams on the first day and 0.6 grams on the second day. All patients were orally administered 0.8 mg,/kg of prednisone. SLE disease activity index （SLEDAI） was used to assess the therapeutic efficacy, and the total scores of SLEDAI （ SLEDAIT ） were divided into clinical scores （ SLEDAIc ） and laboratory scores （ SLEDAIL ）. SLEDAIT, SLEDAIc, and SLEDAIL were recorded before the treatment and 4, 8, and 12 weeks after the treatment. The levels of urine protein, serum complement, and serum ds-DNA before the treatment and 12 weeks after the treatment were determined. Results： Among 48 patients, 41 were followed up to 12 weeks. SLEDAIT, SLEDAIc, and SLEDAIL 4 weeks after treatment were all significantly lower than those before the treatment （ P 〈 0.01 ）. At week 8, only SLEDAIc continued to decrease （ P 〈 0.05）. SLE- DAIT did not decrease significantly at week 12. At week 12, the level of urine protein did not decrease significantly compared with that before the treatment, and the levels of complement C3 and C4 and ds-DNA decreased significantly （ all P 〈 0.01 ）. Conelusion： Intensive pulse CTX plus prednisone is effective in newly diagnosed, untreated patients with SLE. Total dose of CTX could be 6 to 8 grams at week 12 without inducing more adverse effect, and the dose of prednisone is decreased simultaneously.