脐带间充质干细胞对增殖型狼疮性肾炎的临床疗效观察

Efficacy and safety of umbilical cord mesenchymal stem cells on proliferative lupus nephritis

目的探讨脐带间充质干细胞(UCMSC)联合糖皮质激素治疗增殖型狼疮性肾炎(LN)的临床疗效与安全性。方法选取2010年1月至2015年10月在福州总医院肾内科确诊的增殖型LN患者20例,在常规糖皮质激素规律治疗的基础上,自愿接受UCMSC治疗,分析UCMSC治疗LN的疗效、预后及复发情况。统计学分析采用单因素重复测量方差分析和c2检验的方法。结果 20例患者病理分型分别为:Ⅲ型3例(15﹪)、Ⅳ型12例(60﹪)、Ⅲ+Ⅴ型2例(10﹪),Ⅳ+Ⅴ型3例(15﹪)。(1)狼疮活动指数(SLE-DAI)治疗前0周(15.75±3.97)与治疗后4周(13.85±2.56)、8周(12.05±2.61)、16周(9.40±1.85)、24周(8.80±1.36)之间差异均有统计学意义(P均<0.05);(2)20例患者完全缓解8例(40﹪),部分缓解7例(35﹪),无效5例(25﹪),总缓解率为75﹪(15/20);(3)完成UCMSC治疗后随访1年,患者无1例死亡,其中1例于治疗后6月、10月发生肺部感染两次,1例于治疗后8月出现带状疱疹病毒感染,对症治疗均痊愈。4例患者治疗前肌酐轻度升高(最高值达167μmol/L),治疗后肌酐均恢复正常。复发3例,复发率20﹪(1/15);(4)UCMSC治疗过程中最常见的并发症为发热及胃肠道症状,并发症轻,对症处理后均好转。结论本研究表明UCMSC对改善增殖型LN病情及促进缓解有积极作用,起效较快、并发症较少,其远期疗效仍需进一步观察。

ObjectiveTo investigate the efficacy and safety of umbilical cord mesenchymal stem cells （UCMSC） combined with glucocorticoids in the treatment of proliferative lupus nephritis （LN）. MethodsTwenty patients with proliferative LN received UCMSC treatment in addition to the conventional corticosteroid therapy from January 2010 to October 2015, and the efficacy and safety of UCMSC in the treatment of LN were analyzed. One-way repeated-measures ANOVA χ2 test was used for statistical analysis. ResultsPathologically there were 3 cases of type III （15﹪）, 12 of type IV （60﹪）, 2 of types III ＋ V （10﹪）, and 3 of types IV and V （15﹪）. The activity index of lupus nephritis （SLE-DAI） at 4weeks （13.85 ± 2.56）, 8 weeks （12.05 ± 2.61）, 16weeks （9.40 ± 1.85）, and 24 weeks （8.80 ± 1.36） post-treatment were all statistically lower than that prior treatment（15.75 ±3.97） （P 〈 0.05 for all）. Complete remission （40﹪） was observed in 8 patients and partial remission in 7 patients （35﹪）, with an overall response rate of 75﹪ （15/20）; During 1-year follow-up no death occurred. Pulmonary infections occurred at 6 and 10 months after treatment in 1 patient and herpes zoster virus infection occurred at 8 months in 1 patient. Both patients were cured. The mildly elevated serum creatinine levels of 4 patients before treatment （the highest value： 167 umol/L） returned to normal range after treatment. Recurrence happened in three cases （20﹪）. The most common advert recations were fever and gastrointestinal symptoms, and all were mild and improved after treatment. ConclusionThe study demonstrated that UCMSC treatment was effective and safe for proliferative LN. The long-term effect needs to be further observed.