来氟米特与硫唑嘌呤对老年狼疮性肾炎患者血清趋化细胞因子组织蛋白酶及血管细胞黏附分子-1的影响

Effects of Leflunomide and Azathioprine on serum chemokine, cathepsin and vascular cell adhesion molecule-1 in elderly patients with lupus nephritis

目的:分析来氟米特与硫唑嘌呤对老年狼疮性肾炎患者血清趋化细胞因子CX3CL1(Fractalkine)、组织蛋白酶(cathepsin S)及血管细胞黏附分子-1(VCAM-1)的影响。方法:选取我院2017年1月至2019年7月收治的60例老年狼疮性肾炎患者作为研究对象。按随机数字表法分为两组,30例采用来氟米特+常规治疗(来氟米特组),30例采用硫唑嘌呤+常规治疗(硫唑嘌呤组)。检测两组治疗前、治疗后6个月、9个月和12个月血清Fractalkine、cathepsin S及尿VCAM-1水平并进行统计学分析。结果:两组治疗后血清Fractalkine水平均下降(F=123.029、99.041,均P=0.000),来氟米特组治疗后6个月血清Fractalkine水平[(2.34±0.95)μg/L]低于硫唑嘌呤组[(2.97±1.01)μg/L],(t=2.489,P=0.016);两组治疗后血清cathepsin S水平均下降(F=106.733和64.928,均P=0.000),来氟米特组治疗后6个月和9个月血清cathepsin S水平[(24.31±3.15)、(21.72±2.67)μg/L]低于硫唑嘌呤组[(26.92±4.02)、(23.89±2.75)μg/L](t=2.799、3.101,P=0.007,0.003);两组治疗后尿VCAM-1水平均下降(F=907.450和858.114,均P=0.000),来氟米特组治疗后6个月尿VCAM-1水平(74.36±9.17)μg/LCr,低于硫唑嘌呤组(86.91±9.22)μg/L Cr(t=5.286,P=0.000);两组患者不良反应发生率均较低,对比差异无统计学意义。结论:来氟米特与硫唑嘌呤均能有效降低老年狼疮性肾炎患者血清Fractalkine、cathepsin S及尿VCAM-1水平,提示二者在抑制炎症反应、细胞基质降解与重塑、血管细胞黏附方面作用相当,但在治疗前期来氟米特的效果要优于硫唑嘌呤,临床可根据具体情况酌情选择。

Objective To investigate the effects of Leflunomide and Azathioprine on serum chemokine cx3cl1(fractalkine),cathepsin S and vascular cell adhesion molecule-1(VCAM-1)in elderly patients with lupus nephritis.Methods Sixty elderly patients with lupus nephritis admitted to our hospital from January 2017 to July 2019 were selected as the research objects.Patients were divided into two groups by using a random number table method:the Leflunomide group(treated with Leflunomide plus conventional treatment)and the Azathioprine group(treated with azathioprine plus conventional treatment)(n=30,each group).Serum levels of fractalkine and cathepsin S and urine VCAM-1 level before and 6,9 and 12 months after treatment were measured in the two groups and statistically analyzed.Results In both groups,serum fractalkine levels were decreased after versus before treatment(F=123.029 and 99.041 respectively,P=0.000).At 6 months after treatment,serum fractalkine level was lower in the leflunomide group(2.34±0.95)μg/L than in the Azathioprine group(2.97±1.01)μg/L(t=2.489,P=0.016).Serum cathepsin S levels were decreased in both groups after treatment(F=106.733 and 64.928,P=0.000).Serum cathepsin S levels were lower in the Leflunomide group that in the azathioprine group at 6 and 9 months after treatment[(24.31±3.15)μg/L vs.(26.92±4.02)μg/L,(21.72±2.67)μg/L vs.(23.89±2.75)μg/L,t=2.799 and 3.101,P=0.007 and 0.003].After treatment,urinary VCAM-1 levels were decreased in both two treatment groups(F=907.450 and 858.114,P=0.000).At 6 months after treatment,urine VCAM-1 level was lower in the Leflunomide group than in the Azathioprine group[(74.36±9.17)μg/L Cr vs.(86.91±9.22)μg/L Cr,(t=5.286,P=0.000)].The incidences of adverse reactions were low in the two groups,and the difference was not statistically significant.Conclusions Leflunomide and Azathioprine can effectively reduce serum levels of fractalkine and cathepsin S and urinary VCAM-1 in elderly patients with lupus nephritis,which suggests that Leflunomide and Azathioprine have similar effects in inhibiting inflammatory reaction,cell matrix degradation and remodeling and vascular cell adhesion.But at early stage of therapy,the effect of Leflunomide was better than that of Azathioprine.And two drugs can be selected according to the specific clinical situation.