麦考酚酯对系统性红斑狼疮患者T细胞亚群、肾功能、ESR及CRP水平的影响

Effects of mycophenolate mofetil on T cell subsets,renal function,erythrocyte sedimentation rate and C-reactive protein in patients with systemic lupus erythematosus

目的探讨麦考酚酯联合泼尼松及羟氯喹治疗系统性红斑狼疮对患者免疫功能、肾功能、红细胞沉降率(ESR)及C反应蛋白(CRP)水平的影响。方法选取2018年3月至2021年3月舟山医院收治的系统性红斑狼疮患者64例,根据治疗药物不同分为对照组和观察组,对照组33例给予泼尼松+羟氯喹治疗,观察组31例在此基础上给予麦考酚酯治疗。检测两组患者治疗前后T细胞亚群数量、肾功能指标及ESR、CRP水平,评估患者系统性红斑狼疮疾病活动度(SLEDAI)评分,并分析比较。结果两组患者治疗前后CD_(3)^(+)细胞水平比较[(58.23±9.74)%比(59.12±10.59)%,(57.33±10.27)%比(58.85±9.74)%],差异均无统计学意义(t=-0.34、-0.60,均P>0.05);治疗后两组CD_(4)^(+)、CD_(4)^(+)/CD8+均明显升高(均P<0.05),且观察组明显高于对照组[(34.11±5.37)%比(30.95±6.65)%,(1.42±0.33)比(1.23±0.33)](t=-2.08、-2.30,均P<0.05);治疗后两组肌酐(Scr)、尿素氮(BUN)、24 h尿蛋白水平均明显降低(均P<0.05),且观察组均明显低于对照组[(65.36±16.28)μmol/L比(91.88±18.74)μmol/L,(5.19±0.94)mmol/L比(8.57±1.27)mmol/L,(0.12±0.04)g/L比(0.22±0.06)g/L](t=-6.02、-12.03、-7.79,均P<0.05);治疗后两组ESR均明显降低(均P<0.05),且观察组明显低于对照组[(26.36±11.29)mm/h比(39.89±13.74)mm/h](t=-4.28,P<0.05);治疗后两组CRP水平均明显降低(均P<0.05),且观察组明显低于对照组[(7.52±3.23)mg/L比(12.83±5.72)mg/L](t=-4.53,P<0.05);治疗后两组SLEDAI评分均明显降低(均P<0.05),且观察组明显低于对照组[(5.52±1.25)分比(8.25±2.42)分](t=-5.61,P<0.05)。结论在泼尼松联合羟氯喹治疗系统性红斑狼疮患者基础上给予麦考酚酯有利于改善患者免疫功能及肾功能,缓解机体炎症反应,更好地控制疾病活动程度。

Objective To investigate the effects of mycophenolate mofetil combined with prednisone and hydroxychloroquine on immune function,renal function,erythrocyte sedimentation rate and C-reactive protein in patients with systemic lupus erythematosus.Methods A total of 64 patients with systemic lupus erythematosus who received treatment in Zhoushan Hospital from March 2018 to March 2021 were included in this study.These patients were divided into control and observation groups according to different treatment drugs.The control group(n=33)was given prednisone and hydroxychloroquine treatment.The observation group(n=31)was given mycophenolate mofetil treatment based on prednisone and hydroxychloroquine treatment.Before and after treatment,the number of T cell subsets,renal function,erythrocyte sedimentation rate and C-reactive protein level were determined in each group.The Systemic Lupus Erythematosus Disease Activity Index(SLEDAI)was compared between the two groups.Results Before and after treatment,there was no significant difference in CD_(3)^(+)cells between the two groups[control group:(58.23±9.74)%,(59.12±10.59)%;observation group:(57.33±10.27)%,(58.85±9.74)%,t=-0.34,-0.60,both P>0.05].After treatment,CD_(4)^(+)cells and CD_(4)^(+)/CD8+cells in each group were significantly increased compared with those before treatment(both P<0.05).After treatment,CD_(4)^(+)cells and CD_(4)^(+)/CD8+cells in the observation group were significantly higher than those in the control group[(34.11±5.37)%vs.(30.95±6.65)%,(1.42±0.33)vs.(1.23±0.33),t=-2.08,-2.30,both P<0.05].After treatment,serum creatinine,urea nitrogen and 24-hour urine protein in each group were significantly decreased compared with those before treatment(all P<0.05).After treatment,serum creatinine,urea nitrogen and 24-hour urine protein in the observation group were significantly lower than those in the control group[(65.36±16.28)μmol/L vs.(91.88±18.74)μmol/L,(5.19±0.94)mmol/L vs.(8.57±1.27)mmol/L,(0.12±0.04)g/L vs.(0.22±0.06)g/L,t=-6.02,-12.03,-7.79,all P<0.05].After treatment,erythrocyte sedimentation rate in each group was significantly decreased compared with that before treatment(both P<0.05).After treatment,erythrocyte sedimentation rate in the observation group was significantly lower than that in the control group[(26.36±11.29)mm/h vs.(39.89±13.74)mm/h,t=-4.28,P<0.05].After treatment,C-reactive protein level in each group was significantly decreased compared with that before treatment(both P<0.05),and C-reactive protein level in the observation group was significantly lower than that in the control group[(7.52±3.23)mg/L vs.(12.83±5.72)mg/L,t=-4.53,P<0.05].After treatment,SLEDAI in each group was significantly decreased compared with that before treatment(both P<0.05),and SLEDAI in the observation group was significantly lower than that in the control group[(5.52±1.25)points vs.(8.25±2.42)points,t=-5.61,P<0.05].Conclusion Mycophenolate mofetil combined with prednisone and hydroxychloroquine for systemic lupus erythematosus can improve patient's immune function and renal function,reduce the body's inflammatory response,and better lower disease activity.