肾脏替代治疗对狼疮肾炎患者免疫因子及抗体水平的影响

Effect of renal replacement therapy on immune factors and antibody levels in patients with lupus nephritis

目的 探讨肾脏替代治疗对狼疮肾炎患者免疫因子及抗体水平的影响。方法 选取2014年7月至2017年8月本院收治的110例狼疮肾炎患者进行研究,按随机数字表法将其分为两组,各55例。对照组患者给予常规治疗,研究组在此基础上联合肾脏替代治疗,治疗4周后比较两组患者抗体表达水平、免疫因子表达水平及肾功能改善情况。结果 治疗前,各免疫因子表达水平组间比较,差异均无统计学意义(均P>0.05);治疗后,研究组IgG[(10.35±2.32)g/L比(14.64±2.73)g/L]、IgA[(1.72±0.34)g/L比(2.24±0.48)g/L]、IgM[(0.73±0.21)g/L比(1.16±0.36)g/L]表达水平低于对照组,C3[(0.51±0.12)g/L比(0.37±0.11)g/L]、C4[(0.16±0.07)g/L比(0.12±0.04)g/L]表达水平高于对照组,差异均有统计学意义(均P<0.05);治疗前,抗体水平组间比较,差异均无统计学意义(均P>0.05);治疗后,研究组抗C1q抗体[(34.52±7.13)IU/ml比(98.75±10.64)IU/ml]、抗ds-DNA抗体[(101.31±28.76)IU/ml比(124.26±21.53)IU/ml]、抗核小体抗体[(53.81±8.94)IU/ml比(88.25±14.82)IU/ml]表达水平均低于对照组,差异均有统计学意义(均P<0.05);治疗前,肾功能指标组间比较,差异均无统计学意义(均P>0.05);治疗后,研究组SLEDAI评分[(6.26±2.53)分比(8.84±2.37)分]、尿蛋白定量[(0.73±0.21)g/24 h比(1.28±0.26)g/24 h]、尿素氮[(9.61±3.15)mmol/L比(11.04±3.22)mmol/L]、血肌酐[(141.67±65.42)μmol/L比(167.58±70.03)μmol/L]表达水平均低于对照组,差异均有统计学意义(均P<0.05)。结论 肾脏替代治疗可有效改善狼疮肾炎患者抗体及免疫因子表达水平,促进肾功能和临床症状的改善。

Objective To investigate the effect of renal replacement therapy on immune factors and antibody levels in patients with lupus nephritis.Methods 110 patients with lupus nephritis treated at our hospital from July,2014 to August,2017 were chosen as study objects,and were divided into a control group and a research group,55 cases for each group.The control group were treated with routine treatment;and the research group were treated with renal replacement therapy on the basis of the control group.After 4 weeks’treatment,the immune factors and antibody levels,and improvements of renal function were compared between the two group.Results There were no statistical differences in the expressions of immune factors between the two groups before the treatment(all P>0.05).After the treatment,the levels of IgG[(10.35±2.32)g/L vs.(14.64±2.73)g/L],IgA[(1.72±0.34)g/L vs.(2.24±0.48)g/L],and IgM[(0.73±0.21)g/L vs.(1.16±0.36)g/L]were lower and the levels of C3[(0.51±0.12)g/L vs.(0.37±0.11)g/L]and C4[(0.16±0.07)g/L vs.(0.12±0.04)g/L]were higher in the research group than in the control group(all P<0.05).There were no statistical differences in the levels of antibodies between the groups before the treatment(all P>0.05).After the treatment,the levels of anti-C1q antibody[(34.52±7.13)IU/ml vs.(98.75±10.64)IU/ml],anti-ds-DNA antibody[(101.31±28.76)IU/ml vs.(124.26±21.53)IU/ml],and anti-nucleosome antibody[(53.81±8.94)IU/ml vs.(88.25±14.82)IU/ml]were lower in the research group than in the control group(all P<0.05).There was no statistical difference in renal function between the groups before the treatment(P>0.05).After the treatment,the SLEDAI score[(6.26±2.53)vs.(8.84±2.37)]and the levels of urine protein[(0.73±0.21)g/24 h vs.(1.28±0.26)g/24 h],urea nitrogen[(9.61±3.15)mmol/L vs.(11.04±3.22)mmol/L],and creatinine[(141.67±65.42)μmol/L vs.(167.58±70.03)μmol/L]were lower in the research group than in the control group(t=5.519,12.204,2.354,and 2.005,all P<0.05).Conclusion Renal replacement therapy can effectively improve the expressions of antibodies and immune factors in lupus nephritis patients,and improve their renal function and clinical symptoms.