肾脏替代治疗联合免疫吸附对狼疮肾炎患者炎性因子及免疫功能的影响

Effects of renal replacement therapy combined with immune adsorption on inflammatory factors and immune function in patients with lupus nephritis

目的探讨肾脏替代治疗联合免疫吸附(immunoadsorption,IA)对狼疮肾炎(lupus nephritis,LN)患者炎性因子、免疫功能的影响。方法选取94例LN患者作为研究对象,采用随机数字表法分为观察组和对照组,每组47例。2组均给予常规激素和免疫抑制剂治疗,对照组给予IA治疗,观察组给予肾脏替代治疗联合IA,1周为1个疗程,均治疗4个疗程。比较2组治疗前后炎性因子[肿瘤坏死因子α(tumor necrosis factorsα,TNF-α)、白细胞介素6(interleukin-6,IL-6)、白细胞介素8(IL-8)]、免疫功能(免疫球蛋白IgG、IgA、IgM,补体C3、C4)水平、系统性红斑狼疮活动指数(systemic lupus erythematosus activity index,SLEDAI)以及抗体(抗C1q抗体、抗核小体抗体、抗ds-DNA抗体水平)水平。结果治疗前,2组TNF-α、IL-6、IL-8水平比较无差异性(P>0.05);治疗后,2组TNF-α、IL-6、IL-8水平均明显下降,观察组TNF-α、IL-6、IL-8含量明显低于对照组,差异有统计学意义(P<0.05)。治疗前,2组IgG、IgA、IgM、C3、C4水平比较,差异无统计学意义(P>0.05);治疗后,2组IgG、IgA、IgM均明显降低,C3、C4补体水平明显升高,观察组IgG、IgA、IgM水平明显低于对照组,C3、C4明显高于对照组,差异均有统计学意义(P<0.05)。治疗前,2组SLEDAI评分与抗C1q抗体、抗核小体抗体、抗ds-DNA抗体水平比较,差异无统计学意义(P>0.05);治疗后,2组SLEDAI评分与抗C1q抗体、抗核小体抗体、抗ds-DNA抗体水平均明显降低,且观察组明显低于对照组,差异均有统计学意义(P<0.05)。结论肾脏替代治疗联合IA有助于降低LN患者炎性反应,改善机体免疫功能,降低SLEDAI及抗体水平。

Objective To investigate the effect of renal replacement therapy combined with immune adsorption on inflammatory factors and immune function in patients with lupus nephritis.Methods Ninety-four patients with lupus nephritis were selected and randomly divided into the observation group and the control group （n=47 each group）.The patients in two groups were treated with conventional hormone and immunosuppressant.The patients in the control group were treated with PH-350, and those in the observation group were treated with renal replacement therapy combined with immune adsorption for 4 courses （one week of one course）.The inflammatory factors （TNF-alpha, IL-6, IL-8）, immune function （IgG, IgA, IgM, C3, C4）, systemic lupus erythematosus activity index （SLEDAI） and antibody levels （anti C1q antibody, anti nucleosome antibody and anti ds-DNA antibody） were compared between the two groups before and after treatment.Results Before treatment, there was no significant difference in the serum levels of TNF-alpha, IL-6 and IL-8 between the two groups （P〉0.05）.After treatment, TNF-alpha, IL-6 and IL-8 levels in two groups were decreased significantly as compared with those before treatment, and the levels of TNF-alpha, IL-6 and IL-8 in the observation group were significantly lower than those in the control group （P〈0.05）.Before treatment, the levels of IgG, IgA, IgM, C3 and C4 in the two groups were not statistically significant （P〉0.05）.After treatment, the IgG, IgA and IgM levels in two groups were significantly reduced, but C3, C4 complement levels were increased significantly.The levels of IgG, IgA and IgM in the observation group were significantly lower than those in the control group, but the levels of C3 and C4 were significantly higher than those in the control group （P〈0.05）.Before treatment, there was no significant difference between the two groups in SLEDAI score and anti C1q antibody, anti nucleosome antibody and anti ds-DNA antibody （P〉0.05）.After treatment, SLEDAI scores and the levels of anti ds-DNA antibody and anti C1q antibody, anti nucleosome antibody in the two groups were significantly decreased, and those in the observation group were significantly lower those in the control group （P〈0.05）.Conclusions Renal replacement therapy combined with immune adsorption can help reduce inflammation, improve immune function and reduce systemic lupus activity index and antibody level.