霉酚酸酯对红斑狼疮患者疗效及细胞凋亡影响的相关研究

Effect of mycophenolate mofetil on systemic lupus erythematosus and apoptosis of nephrocyte

目的 探讨霉酚酸酯（MMF）治疗红斑狼疮患者的临床疗效及对肾细胞凋亡情况的影响.方法 选取2011年1月至2016年1月来我院治疗的135例红斑狼疮患者,完全随机分为两组,其中一组患者采用激素联合MMF治疗,简称为MMF组;另一组采用激素联合环磷酰胺（CTX）治疗,简称为CTX组.观察比较治疗前及治疗后6个月两组患者SLEDAI评分、血红蛋白、血小板、尿蛋白、血清白蛋白、SCr、C3、ANA（＋）、抗-dsDNA（＋）及aCL（＋）、血清转氨酶等指标的变化情况及治疗过程中不良反应发生情况.采用肾活检及原位末端标记法检测两组患者肾细胞凋亡情况,并比较分析.结果 ①与治疗前比较,两组患者治疗后各指标均有显著改善,差异有统计学意义（P＜0.05）;治疗后,MMF组在血红蛋白、血小板、尿蛋白、抗-dsDNA（＋）方面较CTX组有显著改善,且差异有统计学意义（P＜0.05）.②MMF组患者治疗过程中不良反应发生率显著低于CTX组,差异有统计学意义（P＜0.05）.③MMF组患者肾小管上皮细胞、肾小球及肾间质细胞凋亡数量分别为（29.0±8.9）个、（1.0±0.5）个及（1.4±0.9）个,均显著少于CTX组的（51.5±10.8）个、（4.5±1.5）个及（5.5±1.5）个,差异均有统计学意义（P＜0.05）.结论 MMF在治疗红斑狼疮患者过程中临床效果好,安全性高,且具有阻碍肾细胞凋亡的效果,值得进一步在临床中推广应用.

Objective To study the effect of mycophenolate mofetil on systemic lupus erythematosus （SLE） and apoptosis of nephrocyte.Methods 135 SLE patients treated in our hospital from January 2011 to January 2016 were randomly divided into two groups,patients in one group received the use of hormone and MMF,referred to as MMF group,patients in another group received the use of hormone and cyclophosphamide （CTX）,referred to as CTX group.Recorded the changes of SLEDAI score,hemoglobin,platelet,urine protein,serum albumin,SCr,C3,ANA （＋）,anti-dsDNA （＋）,aCL （＋）,and serum transaminase in both groups before and 6 months after treatment,and recorded adverse reactions in the process of treatment.Apoptosis of nephrocyte of two groups were detected by renal biopsy and in situ end labeling method.Results 1） The indexes in both groups improved significantly after treatment,with statistically significant differences （P〈0.05）;after treatment,hemoglobin,platelet,urine protein,anti-dsDNA （＋） in MMF group were better than those in CTX group,with statistically significant differences （P〈0.05）.2） The incidence of adverse reactions in the process of treatment of MMF group was significantly lower than that of CTX group （P〈0.05）.3） The apoptosis number of renal tubular epithelial cells,renal glomerular cells,and renal interstitial cells of MMF group were （29.0±8.9）,（1.0±0.5）,and （1.4±0.9） respectively,which were significantly less than （51.5±10.8）,（4.5±1.5）,and （5.5±1.5） of CTX group,with statistically significant differences （P〈0.05）.Conclusion MMF has good clinical effect and high safety in the treatment of SLE patients,and obvious obstacles effect to renal cells apoptosis,worthy of further popularization and application in clinical.