环磷酰胺联合霉酚酸酯治疗系统性红斑狼疮难治性蛋白尿的临床研究

Clinical study of cyclophosphamide with mycophenolate mofetil therapy to refractory proteinuria in systemic lupus erythematosus

目的探讨环磷酰胺（CTX）联合霉酚酸酯（MMF）治疗系统性红斑狼疮（SLE）难治性蛋白尿患者的临床疗效与不良反应。方法选取确诊为系统性红斑狼疮并发难治性蛋白尿患者共计66例，随机分为A、B两组，每组均为33例。A组为糖皮质激素（GC）联合CTX治疗，B组为GC＋CTX＋MMF治疗。两组治疗期间其余治疗措施包括抗凝、降脂、控制血压及对症治疗等均基本相同。通过对临床指标包括尿蛋白、补体C3、抗dsDNA抗体、肝肾功能及月经变化等指标进行临床观察12个月。结果B组治疗后在尿蛋白、补体C3、血肌酐（Scr）、尿红细胞及血清白蛋白[分别为（0．95±0．82）g/24h、（0．75±0．23）g／L、（90．50±32．33）μmoL／L、（42．52±10．93）个／μl、（37．6＋7．82）g／L]较A组[分别为（3．10±1．08）g／24h、（0．63±0．20）g／L、（120．20±40．90）μmoL／L、（48．55±11．35）个／μl、（33．52±8．51）g／L]差异均有统计学意义（t值分别为9．77、2．72、3．27、2．20、2．04，P均〈0．05）。结论GC＋CTX＋MMF治疗SLE难治性蛋白尿疗效显著，在治疗过程中均未出现严重不良反应。

Objective Discuss the clinical effects and adverse reaction of cyclophosphamide （CTX） with mycophenolate mofetil （MMF） therapy to refractory proteinuria in systemic lupus erythematosus （SLE）. Methods Sixty-six cases SLE patients were randomly divided them into Group A （33 cases） and Group B （33 cases）. The patients in group A were given Glucocorticoids（GC） with CTX and in group B were given GC＋CTX ＋ MMF. Other treatments were basically the same, including anticoagnlation, lipid-lowering, blood pressure control and other symptomatic treatments. Clinical indicators, including proteinufia, complement C3, anti-dsDNA antibodies, liver and kidney function and menstrual changing were observed for 12 months. Results In group B, proteinuri ,anti dsDNA antibody positive cases number, complement C3, serum creatinine（SCr） , urine red blood cell and serum albumin a number of indicators（ （0. 95±0. 82） g/24 h, （0. 75±0. 23） g/L, （90. 50±32. 33） μmol/L, （ 42. 52 ± 10. 93 ） individual/μl, （ 37.6 ± 7. 82） g/L） were lower than those of in group A （ （ 3. 10±1.08） g/24h,（0.63±0.20） g/L, （12.02±40.90） μmol/L, （48.55± 11.35） individual/μl, （33.52 ± 8.51 ） g/L） after treatment, and the differences were statistically significant （ t = 9. 77,2. 72,3.27,2. 20,2. 04 ; P〈 0. 05 ）. Conclusion GC ＋ CTX ＋ MMF therapy shows an outstanding effect on refractory proteinuria in systemic lupus erythematosus. In addition, there is also no serious negative effect during the process of the treatments.