DNA免疫吸附和传统DMARD对狼疮间质性肺炎患者疗效、肺功能、免疫功能的影响

Comparison of the effect of DNA immune adsorption and conventional DMARD on lung function and endurance of patients with lupus interstitial pneumonia

目的比较DNA免疫吸附和传统缓释性抗风湿剂(DMARD)对狼疮间质性肺炎患者肺功能、免疫功能的影响。方法选取2015年4月—2017年2月湖北省恩施州中心医院呼吸内科收治的狼疮间质性肺炎患者80例为研究对象,采用随机数字表法分为2组各40例,对照组给予传统DMARD及血液净化等常规治疗,观察组在此基础上予以DNA免疫吸附治疗,比较2组治疗总有效率,检测治疗前后用力肺活量(FVC)、第1秒用力呼气量/FVC(FEV_1/FVC)、最大通气量(MVV)及血清免疫球蛋白IgA、IgM,、IgG水平、狼疮活动积分(SLEDAI),并观察不良反应结果观察组治疗总有效率为92.5%,明显高于对照组的75.0%(χ~2=4.501,P=0.034);治疗后观察组FVC、FEV_1/FVC、MVV均高于对照组(t=5.585、18.769、28.979,P=0.000、0.000、0.000),而血清IgA、IgM、IgG及SLEDAI评分较对照组降低(t=3.092、10.670、12.994、20.057,P=0.003、0.000、0.000、0.000);2组不良反应发生率比较差异无统计学意义(χ~2=0.157,P=0.692)。结论 DNA免疫吸附对狼疮间质性肺炎疗效较传统DMARD好,可明显改善患者肺功能、免疫功能,且不会增加不良反应,值得在临床推广应用。

Objective To compare the effect of DNA immune adsorption and conventional disease modifying anti-rheumatic drug （DMARD） on lung function and endurance of patients with lupus interstitial pneumonia.Methods 80 cases of patients with lupus interstitial pneumonia treated in the department of respiration medicine, Central Hospital of Ensi, Hubei province from April 2015 to February 2017 were enrolled in the study.By the random number table method, they were divided into the observation group and the control group with 40 cases in each group.The control group were given routine treatment such as conventional DMARD and blood purification, the observation group were treated with DNA immune adsorption.The total effective rate of treatment was compared between the two groups.The forced vital capacity （FVC）, forced expiratory volume in 1 second /FVC （FEV1/FVC）, the maximal ventilatory volume （MVV）, levels of serum immunoglobulins （IgA, IgM, IgG） and the scores of Systemic Lupus Erythematosus Disease Activity Index （SLEDAI） in the two groups were determined before and after treatment, and adverse reactions were observed.Results The effective rate of treatment in the observation group was significantly higher than that in the control group （92.5% vs.75.0%,χ2=4.501, P =0.034）.After treatment, the VC, FEV1/FVC and MVV of the observation group were significantly higher than those of the control group, while levels of serum IgA, IgM and IgG and SLEDAI score were significantly lower than those in the control group （t =5.585, t =18.769, t =28.979, P =0.000, P =0.000, P =0.000）.The incidence of adverse reactions showed no significant difference between the two groups （7.5% vs 10.0%,χ2=0.157, P =0.692）.Conclusion Compared with conventional DMARD, the curative effect of DNA immune adsorption was better in the treatment of lupus interstitial pneumonia.It can significantly improve the lung function, exercise tolerance and immune function in patients, without increasing adverse reactions.