短期强化免疫吸附治疗重型系统性红斑狼疮的临床疗效

Clinical efficacy of short-term intensive immunoadsorption therapy in the treatment of severe systemic lupus erythematosus

目的探讨短期强化免疫吸附治疗重型系统性红斑狼疮(SLE)患者的有效性和安全性。方法对18例重型SLE患者进行短期强化免疫吸附联合常规治疗。观察治疗后抗双链DNA(dsDNA)抗体、24-h尿蛋白、补体C3和C4水平以及SLE疾病活动指数(SLEDAI),并记录1年随访期间相关临床指标变化。结果与单次免疫吸附相比,短期强化免疫吸附能更有效地清除抗dsDNA抗体(P<0.01)。短期强化免疫吸附后1 d时C3和C4水平高于免疫吸附前,而24-h尿蛋白水平和SLEDAI评分低于免疫吸附前(P<0.01)。与免疫吸附前相比,短期强化免疫吸附后1年随访期间内C3和白蛋白水平增加,SLEDAI评分和24-h尿蛋白水平降低(P<0.05或P<0.01),而WBC、RBC、Plt以及Hb、SCr和BUN水平均无明显变化(P>0.05)。免疫吸附治疗过程中无一例患者发生不良反应。结论短期强化免疫吸附治疗可安全、有效地清除重型SLE患者抗dsDNA抗体,减轻蛋白尿,提高补体水平,快速改善病情。

Objective To investigate the effectiveness and safety of short-term intensive immunoadsorption therapy in the treatment of the patients with severe systemic lupus erythematosus(SLE).Methods Eighteen patients with severe SLE received short-term intensive immunoadsorption therapy combined with conventional therapy.The levels of anti-double stranded DNA(dsDNA)antibody,24-h urine protein,complement component C3 and C4 and SLE disease activity index(SLEDAI)were observed after treatment.The changes of relevant clinical indexes were recorded during 1-year follow-up.Results Compared with single immunoadsorption therapy,the short-term intensive immunoadsorption therapy could more effectively eliminate the anti-dsDNA antibody(P<0.01).The levels of C3 and C4 on the 1^(st)day after short-term intensive immunoadsorption were higher,while the level of 24-h urine protein and SLEDAI score were lower than those before immunoadsorption therapy(P<0.01).Compared with before immunoadsorption therapy,the levels of C3 and albumin were increased,the level of 24-h urine protein and SLEDAI score were decreased(P<0.05 or P<0.01),while WBC,RBC,Plt and levels of Hb,SCr and BUN were not significantly changed within 1-year follow-up after short-term intensive immunoadsorption therapy(P>0.05).No adverse response occurred in 18 cases during the whole immunoadsorption treatment.Conclusion The short-term intensive immunoadsorption therapy can effectively and safely clean out the anti-dsDNA antibody,reduce the proteinuria,elevate the level of complement component and quickly improve the state of illness in the patients with severe SLE.