小剂量联用环磷酰胺和他克莫司诱导治疗狼疮肾炎的疗效分析

Efficacy of Low Dose Combined Cyclophosphamide and Tacrolimus Induc⁃tion in the Treatment of Lupus Nephritis

目的探究小剂量联用环磷酰胺和他克莫司对狼疮肾炎的诱导缓解有效性及对外周血T淋巴细胞的影响。方法选取2018年5月—2022年8月新沂市人民医院风湿免疫科、肾内科收治的60例狼疮肾炎(Lupus Nephritis,LN)患者作为研究对象,按照随机数表法分成两组,各30例。两组患者均采用糖皮质激素、硫酸羟氯喹片等常规基础治疗,对照组使用小剂量环磷酰胺静脉冲击治疗,研究组在对照组基础上加用小剂量他克莫司治疗。治疗6个月后,比较两组患者临床疗效、外周血T淋巴细胞亚群指标及不良反应发生情况。结果研究组的治疗总有效率为93.33%,显著高于对照组的73.33%,差异有统计学意义(χ^(2)=4.320,P<0.05)。研究组的红细胞沉降率、24 h尿蛋白定量、外周血肌酐水平均显著低于对照组,差异有统计学意义(P均<0.05)。研究组的外周血CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)水平均高于对照组,差异有统计学意义(P均<0.05)。研究组的CD8^(+)水平低于对照组,差异有统计学意义(P<0.05)。研究组发生不良反应率为23.33%,与对照组的20.00%比较,差异无统计学意义(χ^(2)=0.098,P>0.05)。结论环磷酰胺及他克莫司的小剂量联合治疗,对狼疮肾炎的缓解效果确切,用药安全性高。

Objective To explore the efficacy of low dose combined cyclophosphamide and tacrolimus in inducing remission of lupus nephritis and the effect on peripheral blood T lymphocytes.Methods A total of 60 patients with lupus nephritis(LN)admitted to the Rheumatology and Immunology and Nephrology Department of Xinyi People's Hospital from May 2018 to August 2022 were selected as the study objects and divided into two groups according to random number table method,with 30 patients in each group.Patients in both groups received conventional basic treatment such as glucocorticoids and hydroxychloroquine sulfate tablets.The control group received low-dose cyclophosphamide intravenous impact therapy,and the study group received low-dose tachlimus on the basis of the control group.After 6 months of treatment,the clinical efficacy,peripheral blood T lymphocyte subsets and the incidence of adverse reactions were compared between the two groups.Results The total effective rate of the study group was 93.33%,which was significantly higher than that of the control group(73.33%),and the difference was statistically significant(χ^(2)=4.320,P<0.05).Erythrocyte sedimentation rate,24 h urinary protein quantity and peripheral blood creatinine level of the study group were significantly lower than those of the control group,and the differences were statistically significant(all P<0.05).The levels of peripheral blood CD3^(+),CD4^(+),CD4^(+)/CD8^(+)in the study group were higher than those in the control group,and the differences were statistically significant(all P<0.05).The level of CD8^(+)in the study group was lower than that in the control group,and the difference was statistically significant(P<0.05).The total incidence of adverse reactions was 23.33%in the study group and 20.00%in the control group,and there was no significant difference between the two groups(χ^(2)=0.098,P>0.05).Conclusion The combined cyclophosphamide and tacrolimus with low dose has definite remission effect on lupus nephritis and high drug safety.