三冲多联疗法治疗重症狼疮性肾炎的疗效观察

Efficacy of Three Pulse Therapy Combine with Multidrug Treatment on Patients with Severe Lupus Nephritis

目的:探讨三冲多联疗法治疗重症狼疮性肾炎的疗效。方法:选择确诊为重症狼疮性肾炎的患者48例,随机分为两组。对照组24例,给予激素、环磷酰胺及抗凝治疗,实验组24例,应用激素、环磷酰胺、丙种球蛋白冲击联合抗凝药物、血液净化、并辨证地配合中医中药疗法。比较两组患者总体缓解情况,治疗前后生化指标、SLEDAI评分、免疫指标等,并分别记录不良反应。结果:实验组患者总体缓解率(91.6%)显著优于对照组(75%),两组比较差异具有统计学意义(P<0.05)。实验组继发感染,柯氏征,神经精神症状及死亡率[分别为8.3%(2例),41.7%(10例),29.2%(7例),4.2%(1例)],显著低于对照组[分别为25.0%(6例),66.7%(16例),54.2%(13例),12.5%(3例)],差异具有统计学意义(P<0.05)。实验组治疗后(1月、3月、6月)尿蛋白、尿红细胞、Cr和SLEDAI评分显著低于对照组,Hb、PLT和Alb显著高于对照组,两组比较差异均有统计学意义(P<0.05)。实验组治疗后ANA滴度、抗dsDNA阳性率显著低于对照组,差异具有统计学意义(P<0.05)。结论:三冲多联疗法对重症狼疮性肾炎患者的疗效显著,具有借鉴意义。

Objective：To investigate the efficacy of three pulse therapy combine with muhidrug treatment on patients with severe lupus nephritis. Methods：The 48 patients with severe lupus nephritis were randomly divided into control group and treatment group. Patients in control group were given treatment of corticosteroids, cyclophosphamide and anticoagulants, and those in treatment group were accepted treatment of corticosteroids, cyclophosphamide, immunoglobulin, anticoagulants, blood purification and Chinese medicine. Compared overall relief of patients＇ condition, biochemical indices, SLEDAI score, and immune indicators before and after treatment, and the adverse reactions are recorded respectively. Results：The total efficiency of treatment group was 91.6%, higher than control group 75%, the difference was statistically significant （P 〈 0.05 ）. The rate of adverse reactions （ infection, cushing syn- dromes, neuropsychic symptom） and death rate of treatment group [8.3% （2 cases） ,41.7% （ 10 cases） ,29.2% （7 cases）, 4.2% （1 cases）] were much less than that of control group [ 25.0% （6 cases）,66.7% （16 cases）,54.2% （13 cases）, 12.5% （3 ca- ses） ]. The difference were statistically significant （ all P 〈 0.05）. Compared with the control group, 24 hours urine protein quantiti- ty, urine RBC, creatinine and the SLEDAI scorces of treatment group after 1,3and 6 months where obviously decreased, hemoglobin, platelet and albumin were obviously increased, the difference was statistically significant （ all P 〈 0.05 ）. The positive rate of ANA and anti ds - DNA antibody of treatment group after 1,3 and 6 months significantly lower than control group, the difference was statistically （ all P 〈 0.05 ）. Conclusion： The efficacy of three pulse therapy for severe lupus nephritis patients is significant, with reference.