IVIG并传统疗法对难治性神经精神狼疮效果及安全性

INTRAVENOUS IMMUNOGLOBULIN COMBINED WITH CONVENTIONAL THERAPY FOR REFRACTORY NEUROPSYCHIATRIC SYSTEMIC LUPUS ERYTHEMATOSUS:ITS EFFICACY AND SAFETY

目的 探讨静注丙种免疫球蛋白（IVIG）联合传统疗法治疗难治性神经精神狼疮（NPSLE）的效果及安全性。方法 选择难治性NPSLE病人15例，应用糖皮质激素、环磷酰胺及IVIG（400 mg/（kg·d），连用5 d）治疗。观察IVIG治疗前及治疗后4周神经精神症状、系统性红斑狼疮疾病活动指数（SLEDAI）及脑脊液的变化，同时观察IVIG治疗过程中的不良反应。结果 IVIG治疗后4周，15例NPSLE病人除1例神经源性膀胱及1例精神病病人无效外，其余13例均完全缓解或好转，有效率达86.7%。与治疗前比较，治疗后NPSLE病人脑脊液白细胞计数减少，蛋白含量下降，压力降低，差异均有显著性（t=5.18-7.77,P〈0.05）；SLEDAI降低，差异有显著性（t=14.35,P〈0.05）。治疗过程中无严重不良反应发生。结论 IVIG联合传统方法治疗难治性NPSLE有较好的效果及安全性。

Objective To evaluate the efficacy and safety of intravenous immunoglobulin （IVIG） combined with conventional therapy in the treatment of refractory neuropsychiatric systemic lupus erythematosus （NPSLE）. Methods Fifteen refractory NPSLE patients were enrolled in this study. Corticosteroid, cyclophosphamide and IVIG （400 mg/（kg·d） were offered for 5 consecutive days. Neuropsychiatric symptoms, changes of SLE disease activity index （SLEDAI） and cerebrospinal fluid （CSF）, before and 4 weeks after IVIG therapy, were observed, and the adverse reactions of IVIG were recorded as well. Results Four weeks after the treatment, of the 15 treated, 13 （86.7%） were completely relieved or improved, excepted one with neurogenic bladder and one with mental disease. Compared with before therapy, CSF index, including white cell count, protein content and pressure declined, the differences being significant （t=5.18-7.77,P〈0.05）, SLEDAI decreased （t=14.35,P〈0.05）. No severe adverse effects were noted in the process of therapy. Conclusion IVIG combined conventional therapy is effective and safe in the treatment of refractory NPSLE.