环磷酰胺联合人免疫球蛋白治疗系统性红斑狼疮的疗效及其对患者血清MCP-4和IL-4的影响

Study on cyclophosphamide combined with human immunoglobulin in the treatment of systemic lupus erythematosus and its effect on the serum levels of MCP-4 and IL-4

目的探讨环磷酰胺联合人免疫球蛋白治疗系统性红斑狼疮的疗效及其对患者血清单核细胞趋化蛋白-4(MCP-4)和白细胞介素-4(IL-4)的影响。方法选取2010年5月至2014年5月我院收治的72例系统性红斑狼疮患者为研究对象,随机将其分为对照组和观察组,每组36例。对照组给予环磷酰胺+强的松治疗,观察组给予人免疫球蛋白+环磷酰胺+强的松治疗。治疗4周后评价两组患者的疗效,并比较两组患者系统性红斑狼疮疾病活动指数(SLEDAI)积分及24 h尿蛋白水平。结果治疗后观察组患者的总有效率为91.7%,高于对照组的72.2%,差异具有统计学意义(P<0.05)。治疗后,观察组患者的血清MCP-4(137.30±13.27)pg/ml、IL-4(3.44±0.53)pg/ml都低于对照组患者的血清MCP-4(168.26±14.12)pg/ml、IL-4(5.04±0.48)pg/ml,差异均具有统计学意义(P<0.05)。治疗后,观察组患者的SLEDAI评分(8.22±2.27)分、24 h尿蛋白(1.31±1.03)g都低于对照组患者的SLEDAI评分(10.14±3.18)分、24 h尿蛋白(2.78±2.39)g,差异均具有统计学意义(P<0.05)。两组不良反应比较差异无统计学意义(P>0.05)。结论环磷酰胺联合人免疫球蛋白治疗系统性红斑狼疮疗效显著,能够有效降低血清IL-4及MCP-4水平,同时能够有效恢复Th1和Th2细胞免疫平衡。

Objective To study the effect of cyclophosphamide combined with human immunoglobulin in the treatment of systemic lupus erythematosus and its effect on the serum levels of monocyte chemoattractant protein-4（MCP-4） and Interleukin-4（IL-4）.Methods We selected 72 patients of systemic lupus erythematosus as the research objects,from May 2010 to May 2014 in our hospital,which were randomly divided into the control group and the observation group,each with 36 cases.The control group received cyclophosphamide,dexamethasone and mannitol.The observation group was given human immunoglobulin,cyclophosphamide,dexamethasone and mannitol.After 4 weeks of treatment,the systemic lupus erythematosus disease activity index（SLEDAI） score,24 h urinary protein levels of the two groups were evaluated and compared.Results The total efficiency of the observation group（91.7%） was higher than that of the control group（72.2%）,and the difference was statistically significant（P〈0.05）.After treatment,the levels of MCP-4,IL-4 in the observation group [（137.30 ± 13.27） pg/ml,（3.44 ± 0.53） pg/ml]were significantly lower than those in the control group [（168.26±14.12） pg/ml,（5.04±0.48） pg/ml],with statistically significant difference（P〈0.05）.After treatment,SLEDAI score,24 h urinary protein in the observation group[（8.22±2.27）,（1.31±1.03） g] were significantly lower than those in the control group [（10.14±3.18）,（2.78±2.39）g],P〈0.05.Conclusion Cyclophosphamide combined with human immunoglobulin has good curative effect in the treatment of systemic lupus erythematosus,which can effectively reduce the serum IL-4 and MCP-4 levels,and can effectively restore the balance of Th1 and Th2 cells.