狼疮性肾炎最新治疗进展

Recent advances in treatment of lupus nephritis

狼疮性肾炎(LN)是系统性红斑狼疮(SLE)患者患病率和病死率最主要的预测因素之一,是影响SLE临床转归的不利因素。十年前,LN的治疗主要限于糖皮质激素(GC)、大剂量的烷化剂和硫唑嘌呤(AZA)。十年来,在LN的诱导与维持治疗方面涌现出了很多新型的免疫调节剂。霉酚酸酯(MMF)的出现使其成为重症LN诱导和维持治疗的有效药物之一,钙调磷酸酶抑制剂(CNI)在小样本随机对照试验中可作为LN的诱导、维持和追加治疗方案。这些新型制剂的应用使得临床医师在尝试获得最大临床受益和最小毒副作用中能够为每一位患者制订最佳的个体化治疗方案。

Lupus nephritis （LN） is one of the primary predictive factors for the prevalence and fatality of patients who have contracted systemic lupus erythematosus （SLE）, and it affects the clinical outcome of SLE patients as an adverse factor. Ten years ago, the treatment of LN was confined to glucocorticoid （GC）, large doses of alkylating agents and acetazolamide （AZA）. Over the past ten years, various new forms of immunomodulators have emerged in the induction and maintenance therapy of LN. Once mycophenolate mofetil （MMF） is available, it becomes one of the effective induction and maintenance treatment drugs for those who get severe LN. Calcineurin inhibitors （CNI）, once widely used in solid-organ transplant patients, have become a type of induction, maintenance and adjuvant therapy plan for LN in small sample RCT. Application of those new forms of immunomodulators makes it possible for clinicians to make the best individual treatment strategies for their patients when they try to get the maximal clinical benefits and the minimal toxic side effects.