他克莫司联合环磷酰胺治疗系统性红斑狼疮的临床效果及对血清MCP4、sIL-2R水平的影响

Clinical Efficacy of Tacrolimus Combined with Cyclophosphamide in the Treatment of Systemic Lupus Erythematosus and Its Effect on Serum MCP4 and sIL-2R Levels

目的:探讨他克莫司联合环磷酰胺治疗系统性红斑狼疮(SLE)的临床效果及对血清单核细胞趋化蛋白4(MCP4)、可溶性白细胞介素-2受体(sIL-2R)水平的影响。方法:选择2019年3月-2021年3月于广州医科大学附属第一医院治疗的86例SLE患者,按随机数字表法将其分为两组,各43例。对照组采用环磷酰胺治疗,观察组采用他克莫司、环磷酰胺联合治疗,连续治疗1个月。比较两组临床疗效、MCP4、sIL-2R、炎症因子、24 h尿蛋白定量(24 h pro)、系统性红斑狼疮疾病活动指数(SLEDAI)评分、免疫指标及不良反应。结果:观察组总有效率高于对照组,差异有统计学意义(P<0.05);治疗后观察组MCP4及sIL-2R均低于对照组(P<0.05);治疗后观察组肿瘤坏死因子(TNF)-α、白细胞介素-6(IL-6)、白细胞介素-8(IL-8)均低于对照组(P<0.05);治疗后观察组24 h pro及SLEDAI评分均低于对照组(P<0.05);治疗后观察组免疫球蛋白A(IgA)、免疫球蛋白G(IgG)、免疫球蛋白M(IgM)均低于对照组,差异均有统计学意义(P<0.05);观察组不良反应发生率低于对照组,差异有统计学意义(P<0.05)。结论:在SLE患者中采用他克莫司、环磷酰胺联合治疗效果更佳,在降低患者病情活动度、血清MCP4、sIL-2R水平及24 h pro方面效果确切,有利于降低炎症反应,改善患者免疫功能,减少不良反应,是治疗SLE较为安全有效的方案。

Objective:To investigate the clinical efficacy of Tacrolimus combined with Cyclophosphamide in the treatment of systemic lupus erythematosus (SLE) and the effects on serum levels of monocyte chemotactic protein 4 (MCP4) and soluble interleukin-2 receptor (sIL-2R).Method:A total of 86 patients with SLE treated in the First Affiliated Hospital of Guangzhou Medical University from March 2019 to March 2021 were selected and divided into two groups according to random number table method,with 43 patients in each group.The control group was treated with Cyclophosphamide,and the observation group was treated with Tacrolimus combined with Cyclophosphamide,continuous treatment for 1 month.Clinical efficacy,MCP4,sIL-2R,inflammatory factors,24 h urinary protein quantification (24 h pro),systemic lupus erythematosus disease activity index (SLEDAI) score,immune indexes and adverse reactions were compared between the two groups.Result:The total effective rate of observation group was higher than that of control group,and the difference was statistically significant (P<0.05).After treatment,the MCP4 and sIL-2R of the observation group were lower than those of the control group (P<0.05).After treatment,tumor necrosis factor (TNF)-α,interleukin-6 (IL-6),interleukin-8 (IL-8) in the observation group were lower than those in the control group (P<0.05).After treatment,the 24 h pro and SLEDAI scores of the observation group were lower than those of the control group (P<0.05).After treatment,the immunoglobulin A (IgA),immunoglobulin G (IgG),immunoglobulin M (IgM) in the observation group were lower than those in the control group,the differences were statistically significant (P<0.05).The total incidence of adverse reactions in the observation group was lower than that in the control group,the difference was statistically significant (P<0.05).Conclusion:The combined treatment of Tacrolimus and Cyclophosphamide has a better effect in patients with SLE.It has an accurate effect in reducing patients’ disease activity,serum MCP4,sIL-2R levels and 24 h pro,which is conducive to reducing inflammatory reaction,improving patients’ immune function and reducing adverse reactions.It is a relatively safe and effective treatment for SLE.