间充质干细胞联合吗替麦考酚酯治疗狼疮性肾炎的临床效果

Clinical effect of mesenchymal stem cells combined with mycophenolate mofetil in the treatment of lupus nephritis

目的 探讨间充质干细胞（MSCs）联合吗替麦考酚酯（MMF）治疗狼疮性肾炎（LN）的临床效果。方法 选取2012年6月~2013年12月本院诊治的22例LN患者作为研究对象,随机分为MSCs联合治疗组、MMF组、对照组。对照组给予糖皮质激素＋环磷酰胺治疗,MMF组给予糖皮质激素＋MMF治疗,MSCs联合治疗组给予糖皮质激素＋MMF＋MSCs治疗。观察三组治疗前后的尿蛋白、血清肌酐、尿素氮、白蛋白、补体C3、补体C4水平及疾病活动指数（SLEDAI）。结果 三组治疗后的尿蛋白、血清肌酐、尿素氮水平显著低于治疗前,血清白蛋白水平显著高于治疗前,差异有统计学意义（P〈0.05）。MSCs联合治疗组与对照组治疗后3个月的尿蛋白水平显著低于MMF组治疗后3个月,血清白蛋白水平显著高于MMF组治疗后3个月,差异有统计学意义（P〈0.05）。MSCs联合治疗组与MMF组治疗后12个月的血清肌酐及尿素氮水平显著低于对照组治疗后12个月,差异有统计学意义（P〈0.05）。三组治疗后3、12个月的C3、C4水平显著高于治疗前,差异有统计学意义（P〈0.05）。MSCs联合治疗组治疗后3、12个月的C3水平显著高于MMF组及对照组,差异有统计学意义（P〈0.05）。三组治疗后3、12个月的SLEDAI评分显著低于治疗前,差异有统计学意义（P〈0.05）。MSCs联合治疗组治疗后3个月的SLEDAI评分显著低于MMF组和对照组,差异有统计学意义（P〈0.05）。结论 MSCs联合MMF治疗LN能够在短期内快速降低尿蛋白,且对肾功能有一定保护作用,可以明显改善病情,降低复发率。

Objective To explore the clinical effect of mesenchymal stem cells （MSCs） combined with mycophenolate mofetil （MMF） in the treatment of lupus nephritis （LN）. Methods 22 patients with LN from June 2012 to December 2013 in our hospital were selected and randomly divided into the MSCs combination treatment group,the MMF group and the control group.The control group was treated with corticosteroids combined with cyclophosphamide,the MMF group was treated with corticosteroids combined with MMF,the MSCs combination treatment group was treated with cor- ticosteroids combined with MMF and MSCs.The level of urine protein,serum creatinine,urea nitrogen,albumin,comple- ments of C3 and C4,systemic lupus erythematosus disease activity index （SLEDAI） before and after treatment among three groups was compared. Results The level of urine protein,serum creatinine,urea nitrogen after treatment among three groups was lower than that before treatment,the level of serum albumin after treatment among three groups was higher than that before treatment,with significant difference （P〈0.05）.The level of urine protein after treatment for 3 months in the MSCs combination treatment group and the control group was lower than that in the MMF group,the level of serum albumin after treatment for 3 months in the MSCs combination treatment group and the control group was higher than that in the MMF group,with significant difference （P〈 0.05）.The level of serum creatinine and urea nitrogen after treatment for 12 months in the MSCs combination treat- ment group and the MMF group was lower than that in the control group,with significant difference （P〈0.05）. The level of C3,C4 after treatment for 3 and 12 months among three groups was higher than that before treatment,with significant difference （P〈0.05）.The level of C3 after treatment for 3 and 12 months in the MSCs combination treatment group was higher than that in the MMF group and the control group,with significant difference （P〈0.05）.The score of SLEDAI after treatment for 3 and 12 months among three groups was lower than that before treatment,with significant difference （P〈0.05）.The score of SLEDAI after treatment for 3 months in the MSCs combination treatment group was lower than that in the MMF group and the control group,with significant dif- ference （P〈0.05）. Conclusion MSCs combined with MMF in the treatment of LN can quickly reduce urine protein in a short term and has some protective role in renal function,which can remarkably improve disease condition and reduce recur- rence rate.