双重血浆滤过治疗重型系统性红斑狼疮的疗效观察

Effectiveness of double filtration plasmapheresis for severe systemic lupus erythematosus

目的评价双重血浆滤过（double filtration plasmapheresis，DFPP）对合并狼疮肾炎（1u—pus nephritis，LN）的重型系统性红斑狼疮（systemic lupus erythematosus，SLE）的治疗效果。方法36例合并LN的重型SLE患者，根据治疗方法分为药物治疗组（对照组）和药物治疗＋DFPP组（DFPP组），每组18例。观察治疗前后肾功能相关指标、免疫学指标以及系统性红斑狼疮疾病活动指数（SLEDAI）的变化情况。结果对照组和DFPP组治疗后24h尿蛋白定量、BUN、SCr、血清胱抑素C均显著下降（P〈0．05），组间比较，DFPP组以上各项指标下降更明显（P〈0．05）。对照组和DFPP治疗组血白蛋白水平治疗前后差异无统计学意义（P〉0．05）。对照组治疗后ANA阳性率、抗ds-DNA阳性率、IgG、IgA、IgM、ESR下降（P〈0．05），补体C3、CA升高（P〈0．05），DFPP治疗组治疗后ANA阳性率、抗ds—DNA阳性率、IgG、IgA、IgM、ESR下降（P〈0．05），而补体C3、C4无统计学差异（P〉0．05）。与对照组相比，DFPP组ANA和抗ds—DNA转阴率更高，IgG下降更明显（P〈0．05）。对照组与DFPP组治疗前后SLEDAI明显下降（P〈0．05），组问比较，DFPP组下降更显著（P〈0．05）。DFPP组疗效优于对照组（P〈0．05）。结论对于合并LN的重型SLE患者，在常规药物治疗的基础上，采用DFPP可显著缓解病情。

Objective To evaluate the clinical effectiveness of double filtration plasmapheresis （DF- PP） in the treatment of severe systemic lupus erythematosus （SLE） complicated with lupus nephritis （LN）. Methods The clinical data of 36 cases of severe SLE in our hospital from Jan. 2004 to Dec. 2011 were ana- lyzeck The patients with SLE were divided into two groups.. DFPP treatment group and control group. Be- fore and after treatment, 24-h urinary protein, urea nitrogen, serum creatinine （SCr）, cystatin C, albumin, immunoglobulin level, complement （23 and CA, autoantibodies （ANA and anti-dsDNA）, erythrocyte sedi- mentation rate （ESR） and SLEDAI score were measured. Results 24-h urinary protein, urea nitrogen, Scr and cystatin C were significantly reduced after treatment as compared with those before treatment in both groups （P〈0.05）, more significantly in DFPP treatment group than in control group （P〈0. 05）. There was significant difference in autoantibodies positive rate （ANA and anti-dsDNA autoantibody）, IgG, IgA, IgM, ESR, C3 and CA before and after treatment in control group （P〈0. 05）. There was significant differ- ence in autoantibedies rate （ANA and anti-dsDNA autoantibody）, IgG, IgA, IgM and ESR before and after treatment in DFPP treatment group （P〈0. 05）. There was no significant difference in C3 and CA before and after treatment in DFPP treatment group （P〉0. 05）. Negative conversion rate of ANA and anti-dsDNA was significantly higher in DFPP treatment group than in control group （P〈0. 05）. IgG was decreased more sig- nificantly in DFPP treatment group （P〈0. 05）. There was significant difference in SLEDAI before and after treatment in both groups （P〈0. 05）. SLEDAI was decreased more significantly in DFPP treatment group（P〈0. 05）. DFPP treatment group showed a greater improvement in therapeutic effects than control group （P〈0. 05）. Conelmiom DFPP combined with hormone and immune depressant can improve the biochemical data and decrease the autoantibody. DFPP may have an important adjuvant role in therapeutic options in the treatment of severe SLE patients with LN complications.