狼疮性肾炎不同免疫抑制治疗方案疗效分析

Different immunosuppressive strategies in the treatment of lupus nephritis

目的比较不同免疫抑制治疗方案治疗狼疮性肾炎(lupus nephritis,LN)的疗效,为今后优化LN的治疗提供参考及依据。方法收集2008年6月至2011年9月广东医学院附属医院肾内科经肾活检诊断为Ⅳ型、Ⅴ型、Ⅴ+Ⅲ型以及Ⅴ+Ⅳ型LN且门诊随诊不低于6个月的患者95例,记录所有患者住院和随诊期间临床及实验室检查结果以及免疫抑制药物使用情况,进行疗效分析。结果不同病理类型LN的诱导缓解率差异无统计学意义,各治疗方案总缓解率可达85%左右。诱导治疗方案以糖皮质激素(P)+环磷酰胺(CTX)为"基本方案",达完全缓解CTX累积用量约2.5 g;达到完全缓解时间约13周;在P+CTX组合治疗基础上加用羟氯喹(HCQ)或雷公藤(TW)未能提高诱导缓解率。维持治疗方案中P+硫唑嘌呤(Aza)的持续缓解时间为83.7周,明显长于其他治疗方案。结论 "个体化"免疫抑制治疗方案对LN的治疗效果满意;在维持治疗方面,P+Aza有更长的持续缓解时间。

Objective To analyze the different immunosuppressive strategies in the treatment of lupus nephritis （LN） and provide evidences for the choices of therapeutic regimen. Methods A total of 95 patients with lupus nephritis of Class IV, Class V , Class III ＋ V , and Class IV ＋ V were included, and followed up for at least 6 months in Institute of Nephrology, the Affiliated Hospital of Guangdong Medical College from Jun. 2008 to Sep. 2011. Clinical parameters, laboratory data and the use of immunosuppressive drugs during the hospitalization and follow-up period were recorded and analyzed retrospectively. Results There was no significant difference in the remission rates among different pathological types. The total remission rate of this individualized regimen was up to more than 85%. Prednison （P） plus cyclophosphamide （CTX） was the ＂basic strategy＂ and the cumulative amount of CTX was about 2. 5 g when complete remission was achieved. And the complete remission time was about 13 weeks. Addition of hydroxychloroquine （HCQ） or tripterygium glycosides （TW） to the combination of P and CTX did not enhance the initial remission rate. Among different maintenance treatment programs, the longest sustained remission was obtained by P plus azathioprinc （Aza）. Conclusion Our individualized immunosuppressive regimen shows satisfactory outcomes in LN patients. The strategy of P plus Aza seems to have a longer sustained remission.