血浆置换联合药物治疗儿童重症系统性红斑狼疮的临床疗效

Clinical Efficacy of Plasma Exchange Combined with Drugs for the Treatment of Severe Systemic Lupus Erythematosus in Children

【目的】观察血浆置换联合激素、霉酚酸酯（MMF）治疗儿童重症系统性红斑狼疮（SLE）的临床疗效。【方法】回顾性分析入住本院的18例重症SLE患儿的I临床资料，观察治疗前后患儿症状、体征（发热、关节疼痛、皮疹、水肿）缓解情况及抗SM抗体、抗ds—DNA抗体、抗RNP抗体、血沉（ESR）、24h尿蛋白、肌酐（SCr）及补体C3的变化。【结果】18例患儿经治疗后症状全部得到好转，其中12例面部红斑消失，2例患儿皮肤表面溃疡愈合，13例患儿雷诺现象消失，发热及关节疼痛明显缓解。ESR由治疗前的（92±24）mm／h降到（27±15）mm／h，24h尿蛋白由治疗前的（8．12±4．76）g降到（1．83±1．55）g，抗SM抗体、抗ds—DNA抗体转阴率明显下降。【结论】血浆置换联合激素、MMF可降低血清自身抗体，有效控制儿童重症SLE，值得临床推广应用。

[Objective] To observe the clinical efficacy of plasma exchange combined with corticoids and myco- phenolate mofetil（MMF） for the treatment of severe systemic lupus erythematosus（SLE） in children. [Methods] Clinical data of 18 children with severe SLE in our hospital were analyzed retrospectively. The improvement of symptoms and signs（fever, joint pain, rash, edema） and anti-SM antibody, anti-ds-DNA antibody, anti-RNP anti- bodies, blood sedimentation（ESR）, 24h urine protein, serum creatinine（Scr） and complement C3 before and after treatment were observed. [Results] Symptoms of all the 18 patients got better after treatment. Facial erythema of 12 patients disappeared. Skin surface ulcer of 2 patients was healed. Raynaud phenomenon of 13 patients disap- peared, and fever and joint pain were alleviated significantly. ESR reduced from （92±24）mm/h to （27＋15）mm/ h, and 24h urinary protein reduced from （8.12±4.76）g to （1.83±1.55）g. The negative conversion rate of anti- SM antibody and anti-ds-DNA antibody decreased obviously. [Conclusion] Plasma exchange combined with corti- colds and MMF can reduce serum autoantibodies and control severe SLE in children, so it is worthy of clinical pro- motion.