DNA免疫吸附在狼疮性肺炎中的疗效探讨

Effect of DNA immune absorption on lupus pneumonia

目的探讨DNA免疫吸附在狼疮间质性肺炎的应用及疗效评估。方法收集18例狼疮肺炎患者作为观察对象随机分组，分免疫吸附组与传统CTX治疗组，观察两组不同时间的红细胞沉降率（ESR）、C反应蛋白（CRP）、抗核抗体（ANA）定量，肺功能测定（一氧化碳弥散量DLCO等）、6 min步行距离及降钙素原（PCT），最后统计分析组间差异及探讨DNA免疫吸附疗效。结果免疫吸附组与对照组治疗前后不同时间点ESR（F组内＝7.841，P〈0.05；F组间＝6.512，P〈0.05; F交互＝10.421，P〈0.05）、CRP（F组内＝6.995，P〈0.05；F组间＝5.847，P〈0.05; F交互＝8.847，P〈0.05）及ANA定量（F组内＝12.336，P〈0.05；F组间＝11.214，P〈0.05; F交互＝15.847，P〈0.05）比较差异均有统计学意义，且免疫吸附组CRP、ESR治疗1、2周开始下降且与治疗前比较差异均有统计学意义（P均〈0.05），而对照组治疗4周后与治疗前比较差异均有统计学意义（P均〈0.05）；免疫吸附组ANA定量治疗2周后与治疗前比较差异有统计学意义（P〈0.05），而对照组6个月后与治疗前比较差异有统计学意义（P〈0.05）。免疫吸附组与对照组治疗前后不同时间点肺功能（F组内＝6.222，P〈0.05；F组间＝7.154，P〈0.05; F交互＝8.527，P〈0.05）、6 min步行距离（F组内＝8.669，P〈0.05；F组间＝7.154，P〈0.05; F交互＝11.547，P〈0.05）及PCT（ F组内＝5.621，P〈0.05；F组间＝4.125，P〈0.05; F交互＝7.554，P〈0.05）比较差异亦均有统计学意义且免疫吸附组患者肺功能、6 min步行距离治疗2周与治疗前比较差异均有统计学意义，对照组则4周后与治疗前比较差异均有统计学意义（P均〈0.05）；免疫吸附组PCT治疗2周后与治疗前比较差异有统计学意义（P均〈0.05），对照组治疗3月后与治疗前比较差异均有统计学意义（P均〈0.05）。 结论狼疮间质性肺炎治疗传统方案治疗效果欠佳，DNA免疫吸附疗效确定，优于传统方案，而且感染风险降低。

ObjectiveTo investigate the clinical application and efficacy of DNA immune absorption in patients with lupus interstitial pneumonia.Methodsto collect randomized 18 patients with lupus patients with pneumonia were enrolled in the study and randomly divided into immunoadsorption group and traditional CTX treatment group, in order to observe the ESR, CRP, ANA quantitative monitoring at different time, pulmonary function test （diffusing capacity of the lung for carbon monoxide, DLCO）, 6 min walking distance, procalcitonin（PCT）. The difference between groups was statistically analyzed and the effect of DNA immunization was discussed.ResultsThere were significant differences between immunoadsorption group and control group in ESR at the different time points before and after the treatment（Fgroup=7.841, P〈0.05; Fcross=6.512, P〈0.05; Finteraction=10.421, P〈0.05）, CRP（Fgroup=6.995, P〈0.05; Fcross=5.847, P〈0.05; Finteraction=8.847, P〈0.05） and ANA quantitative monitoring（FgrouP=12.336, P〈0.05; Fcross=11.214, P〈0.05; Finteraction=15.847, P〈0.05）. At 1 and 2 weeks after treatment, CRP and ESR of the immunoadsorption group began to decrease, and the difference was statistically significant compared with those before treatment （P〈0.05）, while the difference between the control group and the treatment group was statistically significant after 4 weeks （P〈0.05）. After 2 weeks of treatment, there was a significant difference in ANA quantitative monitoring between the immunoadsorption group, compared with that before treatment.There was a significant difference between the control group before treatment and the 6 months after treatment （P〈0.05）. There was a significant difference between the immunoadsorption group and the control group in pulmonary function test（FgrouP=6.222, P〈0.05; Fcross=7.154, P〈0.05; Finteraction=8.527, P〈0.05）, 6 min walking distance（FgrouP=8.669, P〈0.05; Fcross=7.154, P〈0.05; Finteraction=11.547, P〈0.05） and PCT（ FgrouP=5.621, P〈0.05; Fcross=4.125, P〈0.05; Finteraction=7.554, P〈0.05.The pulmonary function and 6 min walking distance of 2-week treatment in the immunoadsorption group.There showed a significant difference compared with that before treatment.The difference between the control group after 4 weeks of treatment and that before treatment was statistically significant （P=〈0.05）. There was a significant difference between the 2 weeks PCT treatment in the immunoadsorption group and that before treatment （P〈0.05）. There was a significant difference between the control group after 3 months of treatment and before treatment（P〈0.05）.ConclusionThe treatment of lupus interstitial pneumonia in traditional regimens is ineffective, and the efficacy of DNA is better than that of conventional regimens, and reduces the risk of infection.