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两种环磷酰胺冲击方案对狼疮性肾炎的疗效和肿瘤坏死因子的影响

Effects of Two Different Regimens of Pulse Cyclophosphamide on Clinical Activity and TNF Levels in Lupus Nephritis
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摘要 目的 探讨大剂量环磷酰胺静脉冲击治疗狼疮性肾炎 (LN)的合理方案及对肿瘤坏死因子 (TNF)水平的影响。方法 将 51例LN患者分为A ,B两组 ,分别给予 2周 (A组 )和 4周 (B组 )一次环磷酰胺静脉冲击治疗 (IV CYC) ,每次用量 0 .5~ 1.0g/m2 ,同时口服强的松 1mg·kg- 1·d- 1。用ELISA双抗体夹心法检测LN患者血清和尿TNF水平。结果 A组病情缓解率显著高于B组 (P <0 .0 5)。活动期LN患者血清和尿TNF水平显著高于稳定期 ,轻度肾功不全患者血清TNF水平显著高于肾功正常者 (P <0 .0 5)。结论 IV CYC加强的松治疗能显著降低LN患者尿TNF水平且 2周方案优于 4周方案 ,治疗中应根据病情、外周白细胞数和肾功能调整 ,重症和急进期LN每 2周 1次 ,病情轻者可每 4周 1次 ,血清和尿TNF的变化有助于监测狼疮活动和肾损害程度。 Objective To investigate reasonable regimen of cyclophosphamide(CYC) pulse therapy and effects of CYC pulse on levels of tumor necrosis factor(TNF) in lupus nephritis(LN).Method 51 LN cases were divided into two groups.The pulse intermittence were 2 weeks for group A and 4 weeks for group B.Each pulse dose of CYC was 0.5~1.0g/m 2.Every patients took prednisone 1mg·kg -1 ·d -1 daily for first 8 weeks and then tapered.Serum and urinary levels of TNF were determined by using sandwich ELISA in 51 LN patients.Result Remission rate in group A was higer significantly than that in group B (P<0.05).Incidence of leukopenia in group A(38%) was significantly higher than that in group B.Conclusion Compared with Group B,urinary TNF levels in LN patients from Group A were obviously lower at 4 weeks after treated with IV CYC(P<0.01).A reasonable IV CYC should be modulated according to the disease activity and WBC counting.IV CYCwith two weeks intermittence should be used for acute and severe LN.IV CYC with four weeks intermittence is recommended when disease is mild.TNF may be take part in immune pathogenesis of LN.Serum and urinary levels of TNF may be an useful indicator for monitoring disease activity and degree of renal damage in LN. [
出处 《潍坊医学院学报》 2001年第2期91-93,共3页 Acta Academiae Medicinae Weifang
关键词 狼疮性肾炎 环磷酰胺 肿瘤坏死因子 治疗 Lupus nephritis Cyclophosphamide Tumor necrsis factor
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  • 1叶任高,新医学,1990年,21卷,428页
  • 2叶任高,中华肾脏病杂志,1990年,6卷,379页
  • 3李士梅,临床肾脏病学,1986年

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