免疫吸附治疗狼疮性肾炎的临床疗效

Clinical Efficacy of Immunoadsorption in Lupus Nephritis Treatment

【目的】探讨免疫吸附治疗狼疮性肾炎患者的临床疗效。【方法】选择本院收治的40例活动性狼疮性肾炎患者，随机分为免疫吸附组（A组）和常规治疗组（B组），每组各20例。B组应用糖皮质激素（甲泼尼龙、泼尼松龙）及免疫抑制荆（环磷酰胺）治疗，A组在常规治疗的基础上，予以免疫吸附柱进行血液吸附，每月2次，连续3个月，共计6次。治疗前及免疫吸附末次治疗后，分别收集患者血标本，测定抗核抗体（ANA）、抗双链DNA抗体（ds—DNA）的清除效果及对患者血常规、血沉、免疫球蛋白、补体、肾功能等的影响，并观察记录其临床表现变化。【结果】治疗后两组患者的症状和体征均明显改善，且A组优于B组；两组患者治疗后ANA抗体滴度，抗ds—DNA抗体，免疫球蛋白较治疗前均显著下降（P〈0．05），且A组较B组下降更为明显，其差异有显著性（P〈0．05）；两组治疗前后血常规、血沉、补体等无明显变化。【结论】免疫吸附治疗狼疮性肾炎特异性强，毒副反应较少，能明显改善患者临床症状，可能成为狼疮性肾炎多靶点疗法新的联合治疗手段。

[Objective]To observe the clinical effect of immunoadsorption on patients with lupus nephritis. [Methods]40 patients with active lupus nephritis were randomly divided into 20 cases of conventional treatment and 20 cases of immunoadsorption. Conventional treatment group used glucocorticoid （methylprednisolone and prednisone） and immunosuppressive agents （cyclophosphamide） treatment ; immune adsorption group, in addition to routine treatment, underwent immune adsorption column adsorption of blood, twice a month for 3 months （total six times）. Before and after blood samples of patients were collected to determine levels of antinuclear antibodies （ANA）, scavenging effect of anti double stranded DNA （anti dsDNA）, and the influence degree of patients＇ blood such as erythrocyte sedimentation rate （ESR）, immunoglobulin protein, complement, and renal function. Meanwhile clinical performance of patients was observed and recorded. [Results]The symptoms and signs of patients were improved obviously after the treatment of immune adsorption; ana droplet of adsorption decreased [1 ： 2000 and 1 ：300, P〈0.001）]; anti DS DNA antibody adsorption decreased significantly （36.5±10.4） IU/mL and （19.4±10.3） IU/mL; immune globulin decreased significantly （P 〈 0.05） ; blood, erythrocyte sedimentation rate （ESR）, complement, etc. no obvious effect. [Conclusion] Immune adsorption therapy for lupus nephritis with strong specificity, less toxic and side effects, can significantly improve the clinical symptoms, may become a more targeted therapy for lupus nephritis new combination therapy.