老年性狼疮性肾炎患者采用免疫抑制剂治疗的临床效果观察

The clinical effect of immunosuppressive therapy in senile LN patients

目的探讨老年性狼疮性肾炎(LN)患者采用免疫抑制剂环磷酰胺(CTX)联合吗替麦考酚酯(MMF)治疗的临床效果。方法采用随机数值表法将2011年8月至2016年5月收治的90例老年LN患者作为研究对象,随机将其分为CTX组、MMF组、CTX+MMF组,各30例。CTX组患者给予静脉CTX每月0.8 g/次治疗,MMF组给予口服MMF0.75 g/d治疗,CTX+MMF组给予静脉CTX每月0.6 g/次和MMF 0.75 g/d联合治疗。比较3组患者治疗24 h后个各项临床指标变化情况,治疗6个月后比较3组患者的治疗效果。结果治疗后24 h 3组患者尿蛋白定量、24 h尿素氮、红细胞沉降率(ESR)、补体C3、肌酐(Scr)、抗ds-DNA及白蛋白(ALB)与治疗前相比均明显改善(P<0.05),且CTX+MMF组患者治疗后上述指标均明显优于CTX组及MMF组(P<0.05)。评价3组患者治疗效果,CTX组总有效率为73.3%,MMF组为70.0%,CTX+MMF组为93.3%,CTX+MMF组明显高于CTX组和MMF组(P<0.05);比较3组患者治疗过程中不良反应发生率,CTX组患者恶心呕吐、白细胞减少和出血性膀胱发生率均明高于CTX+MMF组和MMF组)(P<0.05)。结论与单用CTX或MMF方案相比较,对老年性LN患者应用小剂量CTX联合MMF的治疗方案效果更为显著,同时也减少了由CTX引发的不良反应,安全性更高。

Objective To investigate the clinical effect of cyclophosphamide （Cyclophosphamide, CTX） combined with mycophenolate mofetil （Mycophenolate mofetil, MMF） in the elderly lupus nephritis （Lupus, nephritis, LN）.Methods 90 cases in our hospital from 2011 August to 2016 May in Department of internal medicine of nephropathy treated patients were divided into CTX group, MMF group, CTX ＋ MMF group with 30 cases in each group Using random number table method.Group CTX： using CTX 0.8 g/month;MM group： by oral administration of MMF 1.5 g/d, points two times oral;group CTX ＋ MMF：0.6 g/month combined with MMF 0.75 g/d.After 6 months of clinical curative effect and treatment of various clinical indicators were compared between the three groups of the situation.Results After the treatment three groups of patients with 24 h urine protein, ESR, complement C3, Scr, blood urea nitrogen, anti ds-DNA, AIB compared with those before treatment were significantly improved after treatment （P〈0. 05）.And the above indexes of CTX ＋ MMF group was superior to that of CTX, MMF group （P〈0. 05）.The total efficiency of CTX＋MMF group 93.3% was significantly higher than that of CTX （73.3%） and MMF group （70%） （P〈0. 05）.The rate of nausea and vomiting, the white blood cell reduction rate, hemorrhagic cystitis in group CTX were significantly higher than those in MMF group and CTX＋MMF group （P〈0. 05）.Conclusion The clinical curative effect of using small dose of CTX ＋ MMF regimen in treatment of senile patients with LN is better, also can effectively reduce the adverse reactions of high dose of CTX.