自体造血干细胞移植治疗系统性红斑狼疮随访

Autologous hematopoietic stem cell transplantation for systemic lupus erythematosus lO-year followup

目的探讨自体造血干细胞移植治疗系统性红斑狼疮（SLE）的远期疗效。方法分析48例接受自体造血干细胞移植的SLE患者于移植后的随访情况，自诊断时间计算，病程均超过10年。其中24例为CD34＋细胞纯化移植，24例非CD34＋细胞纯化移植。采用矿检验进行统计分析。结果死亡5例，移植相关死亡4例，其中3例为CD34^＋移植。自诊断病程超过10年的生存率为90％（43／48）。可评价的43例中，复发7例，6例为非CD34＋细胞纯化移植，1例为CD34＋细胞纯化移植。CD34^＋细胞纯化移植复发率为5％（1／21），非CD34^＋细胞纯化移植复发率为27％（6／22），2组间复发率差异有统计学意义（X^=3．995，P=0．046）。随访中，8例上大学，26例恢复正常工作与生活，其中4例生育子女。结论自体造血干细胞移植联合抗人胸腺球蛋白（ATG）治疗SLE的远期疗效确切，CD34^＋移植复发率低于非CD34^＋移植，尤其是SLE患者移植后生活质量好于传统治疗。

Objective To investigate the long-term efficacy of autologous stem cell transplantation for systemic lupus erythematosus （SLE）. Methods Long-term follow up of 48 SLE patients with autologous stem cell transplantation were studied. All patients were followed up for 10 years. Among the patients, 24 eases were treated with purified CD34^＋ cells transplantation and 24 eases were treated with non-CD34^＋ cell transplantation. Comparison between groups was performed by X2 test. Results Among 5 dead patients, 4 died of transplantation related eomplications including 3 eases treated with CD34^＋ transplantion. The survival rate of those patients with more than 10 years duration of lupus was 90%（43/48）. Among 43 patients, 7 had disease flare, 6 were treated with non-CD34^＋ eell transplantation. Eight patients went to college, 26 returned to normal life and 4 of them had children. Conclusion The long-term effect of SLE treated with autologous hematopoietic stem cell transplantation and anti-thymoeyte globulin （ATG） is good. The recurrence of CD34^＋ transplant patients is lower than those treated with non-CD34^＋ transplantation. The quality of life in SLE patients treated with transplantation is better than those treated with conventional therapy.