DNA免疫吸附疗法治疗狼疮间质性肺炎的近期疗效及安全性分析

Short-term curative effect and safety of DNA immunoadsorption therapy in the treatment of lupus interstitial pneumonia

目的:分析DNA免疫吸附疗法治疗狼疮间质性肺炎的近期疗效及安全性。方法:选取2016年1—12月广东省惠州市中心人民医院收治的80例狼疮间质性肺炎患者,按随机数字表法分为观察组和对照组,每组40例。对照组采用甲强龙+泼尼松+环磷酰胺冲击治疗,观察组在对照组治疗基础上加用DNA免疫吸附治疗。比较两组患者的近期疗效、高分辨CT评分、6 min步行距离及不良反应发生率。分别于治疗前、后测定患者血清免疫球蛋白、抗核抗体(ANA)滴度、抗双链DNA抗体(抗ds-DNA抗体)及补体水平。观察治疗前、后患者的肺活量(VC)、用力肺活量占预计值百分比(FVC%)、单位肺泡容积一氧化碳弥散量占预计值百分比(DLCO/VA)、1 s用力呼吸容积(FEV1)占用力肺活量百分比(FEV1/FVC)等肺功能指标的变化。结果:治疗后,观察组IgG、IgM、IgA、ANA、抗ds-DNA水平、高分辨CT评分低于对照组,而C3水平高于、6 min步行距离长于对照组,差异均有统计学意义(均P<0.05)。观察组治疗后VC、FVC%、FEV1/FVC、DLCO/VA均高于对照组(P<0.05)。观察组治疗总有效率明显高于对照组(P<0.05),两组不良反应发生率比较差异无统计学意义(P>0.05)。结论:DNA免疫吸附疗法可提高狼疮间质性肺炎的临床疗效,改善患者的免疫功能及肺功能。

Objective： To investigate the short-term curative effect and safety of DNA immunoadsorption therapy in the treatment of lupus interstitial pneumonia. Methods： 80 patients with lupus interstitial pneumonia admitted to our hospital from January 2016 to December 2016 were selected and were randomly divided into a control group and an observation group, with 40 cases in each group. The patients in the control group were treated with methylprednisolone, prednisone and cyclophosphamide pulse therapy, while those in the observation group were treated as the control group with addition of DNA immunoadsorption therapy. The short-term curative effect and the incidence of adverse reactions were compared between the two groups. The serum immunoglobulin, antinuclear antibody （ANA） titers, anti-double stranded DNA antibody （anti ds-DNA antibody） and complement levels were determined before and after treatment. Lung high-resolution CT examination was performed to observe relief of interstitial lung disease. The changes of lung function indexes such as vital capacity （VC）, percentage of forced vital capacity in predicted value （FVC%）, percentage of diffusion capacity for carbon monoxide of the lung in predicted value （DLCO/VA） and percentage of forced expiratory volume in one second （FEV1） in forced vital capacity （FEV1/FVC） before and after treatment were detected. 6 min walking test was performed to record the changes of walking distance before and after treatment. Results： After treatment, levels of IgG, IgM, IgA, ANA and anti ds-DNA were lower in the observation group than those in the control group, while the C3 level and walking distance within 6 min were higher （P〈0. 05 ）. VC, FVC%, FEV1/FVC and DLCONA in the observation group were higher than those in the control group （P〈0. 05）. The total effective rate in the observation group was higher than that in the control group （P〈0. 05 ）. No significant difference was noted in the incidence of adverse reaction between the two groups （P〉 0. 05）. Conclusion： DNA immunoadsorption therapy could elevate the efficacy of lupus interstitial pneumonia, improve immune function and pulmonary function of patients.