脱氧核糖核酸免疫吸附治疗狼疮性肾炎的疗效比较

Deoxyribonucleic Acid Immunoadsorption Treatment of Lupus Nephritis Comparison

目的：探讨免疫吸附治疗狼疮性肾炎的临床疗效。方法：2004年1月至2005年6月间在盐城市第一人民医院肾脏科住院的狼疮性肾炎患者，所有患者均有明显血尿、尿蛋白＞2．0g／d，肾功能异常，血肌酐（SCr）278．39±80．73／μmol。其中15例狼疮性肾炎根据病情采用脱氧核糖核酸（DNA）免疫吸附柱清除患者血浆中特有的异常增多的抗双链脱氧核糖核酸抗体（抗ds—DNA抗体）及免疫复合物。免疫吸附治疗2～3次，平均（2．0±0．35）次，同时口服小剂量强的松0．5mg／kg·d）及间断环磷酰胺（CTX）静脉冲击（总量6～8g）。另15例患者给予大剂量强的松1mg／kg·d）及间断CTX静脉冲击治疗作为对照组，比较两组治疗后好转率（完全缓解率＋部分缓解率）。结果：30例患者随访6个月，免疫吸附治疗患者的好转率为80．00％，明显高于对照组53．33％，P＜0．01。结论：免疫吸附联合小剂量激素及间断CTX冲击，能有效控制狼疮性肾炎活动，明显改善肾功能。

Objective： Discussion clinical efficacy of Immunoadsorption in treatment of lupus nephritis. Method： All patients with lupus nephritis, who were treated in yancheng first people＇s hospital from Jan. 2004 to Jun. 2005, were included in this study. They all presented with macrographic hematuria. Related ：laboratory tests showed their urine protein more than 2.0 g/d and abnormal renal function （ serum creatinine 278.39 ＋ 80.73/μmol ）. 15 patients were choosed according to their pathogenetic conditions to treat using deoxyribonucleic acid （ DNA ） immunoadsorption method two or three times （ average 2.0 ± 0.35 ） . In this treatment course, their specific excessive anti - dsDNA antibody and immune complex were cleared with immunoadsorption column. Meanwhile, low dose prednisoner （ 0.5mg/kg · d ） was administrated orally and cyclophosphamide （ CTX, total 6 - 8 g ） intermittent intravenous pulse therapy was given intravenously. Other 15 patients were treated only with high dose prednisoner（ 1 mg/kg · d ） oral administration and cyclophosphamide intermittent intravenous pulse therap as control. The improvement rate （ complete improvement rate ＋ partial improvement rate ） was compared between the two groups. Result： The improvement rate of the immunoadsorption therapy goup at six months of follow up was 80.00% and significantly higher than that of the control group（ 53.33% ） ,P 〈0.01. Conclusion： Immunoadsorption method combined with low dose prednisoner oral administration and cyelophosphamide intermittent intravenous pulse therapy is effctive on the control of lupus nephritis activity and the improvement of renal function .