免疫抑制剂不同冲击疗法治疗狼疮性肾炎的临床研究

Clinical studies on treatment for lupus nephritis with different lash therapy of immunosuppressive agent

目的 :探讨免疫抑制剂不同疗法治疗狼疮性肾炎的疗效。方法 :46例患者随机分为 3组。甲基氢化泼尼松 (MP)冲击组 :15例患者采用 MP1.0 g+5 %葡萄糖 2 5 0 ml静滴 ,每日 1次 ,连用 3日 ,以后根据病情可连续应用 2～ 3个疗程。环磷酰胺 (CTX)冲击组 :15例患者采用 CTX 0 .8～ 1.0 g/1.73m2 静滴 ,每月 1次 ,连续6～ 8个月。其他 16例患者采用 MP联合 CTX冲击治疗 (MP+CTX冲击组 ) :方法同上。每组患者均常规应用泼尼松治疗。在治疗前后检测 2 4小时尿蛋白定量、血肌酐、C3、C4、抗核抗体 (ANA )的变化。结果 :治疗 6个月后 ,MP组、CTX组及 MP+CTX组对狼疮性肾炎的疗效分别为 80 .0 %、81.3%、和 93.3%。各组尿蛋白 2 4小时定量、血肌酐、C3、C4升高治疗前后均有显著性差异 (P均 <0 .0 5 ) ;而 MP+CTX组较 MP组和 CTX组差异更明显 (P均 <0 .0 5 )。结论 :MP与 CTX冲击疗法治疗狼疮性肾炎的疗效肯定 ,而两者联合冲击的疗效更好。

Objective:To investigate the clinically curative effects of different therapeutic mathod of immunosuppressive agent for lupus nephritis(LN).Methods:Fortysix patients with LN were randomly divided into three groups:methylprednisolone(MP) group( n =15) was treated with MP 1 0 g+5% glucose 250 ml infused intravenously once a day for three days as a therapeutic course then based on the patients condition additional 23 therapeutic course could be used. The cyclophosphamide(CTX) group( n=15 ) was treated with CTX 0 81 0 g/1 73 m 2 body surface area (BSA) infused intravenously once a month for 68 months. The MP+CTX group( n =16) was treated with MP+CTX using the same method as MP and CTX group.Otherwise the conventional prednisone therapy was given to three groups.Before and after therapy the changes in quantitative measurement of 24 hours urinary protein,blood creatinine(Cr),complement C3,C4,and antinuclear antibody(ANA) were detected.Results:After 6month therapy the curative effects on LN were 80 0% in MP group,81 3% in CTX group,and 93 3% in MP+CTX group respectively.There were significant differences in quantitative measurement of 24 hours urinary protein,blood Cr,C3,and C4 before and after therapy (all P <0 05) furthermore the differences in MP+CTX group compared with MP group and CTX group were much more significant (all P <0 05).Conclusions:The curative effects of MP and CTX on LN are cofirmed and the combined lash therapy using both MP and CTX is much more effective.