环磷酰胺联合激素诱导治疗狼疮性肾炎的临床效果(1)
【摘要】 目的：评价环磷酰胺(CTX)联合泼尼松在诱导治疗狼疮性肾炎(LN)中的效果。方法：选取2016年9月-2018年6月乐山市人民医院收治的LN患者62例。所有患者均给予CTX冲击联合泼尼松诱导治疗。于治疗前及治疗后分别测定SLE疾病活动指数(SLEDAI)、24 h尿蛋白、外周血白细胞、血红蛋白、血小板、总蛋白、白蛋白、尿素、肌酐、尿酸、补体C3和C4的变化情况，评估临床疗效。结果：治疗后1个月，外周血白细胞、血红蛋白、白蛋白、补体C3、24 h尿蛋白、SLEDAI评分均较治疗前明显改善(P<0.05)，总有效率为12.9%;治疗后6个月，总蛋白、补体C4与治疗前比较明显改善(P<0.05);治疗后6个月，血红蛋白、总蛋白、白蛋白、补体C3、24 h尿蛋白、SLEDAI评分均较治疗后1个月明显改善(P<0.05)，总有效率70.96%。而治疗后1个月及治疗后6个月，血小板、尿素、肌酐、尿酸均无明显改善(P>0.05)。结论：CTX联合泼尼松诱导治疗LN的效果显著，值得在临床中采纳及应用。
【关键词】 环磷酰胺 泼尼松 狼疮性肾炎
doi：10.14033/j.cnki.cfmr.2020.23.010 文献标识码 B 文章编号 1674-6805(2020)23-00-03
Clinical Efficacy of Cyclophosphamide Combined with Hormone Induction in the Treatment of Lupus Nephritis/LI Bojiang， XIAO Youwen， DONG Jianhua， HE Ling， PAN Hongxia. //Chinese and Foreign Medical Research， 2020， 18(23)： -30
[Abstract] Objective： To evaluate the efficacy of Cyclophosphamide (CTX) combined with Prednisone in the induction treatment of lupus nephritis (LN). Method： Sixty-two LN patients admitted in Leshan People’s Hospital from September 2016 to June 2018 were selected. All patients were treated with CTX shock combined with Prednisone induction. Systemic lupus erythematosus disease activity index (SLEDAI)， 24 h urine protein， peripheral blood leukocyte， hemoglobin， platelet， total protein， albumin， urea， creatinine， uric acid， complement C3 and C4 were observed before and after treatment. Curative effect was evaluated. Result： One month after treatment， peripheral blood leukocyte， hemoglobin， albumin， complement C3， 24 h urine protein and SLEDAI score were significantly improved compared with those before treatment (P<0.05). The total effective rate was 12.9%. Six months after treatment， total protein and complement C4 were significantly improved compared with those before treatment (P<0.05). At six months after treatment， hemoglobin， total protein， albumin， complement C3， 24 h urine protein， and SLEDAI score were significantly improved compared with one month after treatment (P<0.05). The total effective rate was 70.96%. However， there were no significant improvement in platelet， urea， creatinine and uric acid after one month and six months (P>0.05). Conclusion： CTX combined with Prednisone induction treatment for LN is effective and worthy of clinical application.
[Key words] Cyclophosphamide Prednisone Lupus nephritis
First-author’s address： Leshan People’s Hospital， Leshan 614000， China
系統性红斑狼疮(systemic lupus erythematosus，SLE)是一种复杂的、病因未明的异质性自身免疫性疾病，好发于育龄女性，血清学特征为抗双链DNA抗体、抗Smith抗体、抗组蛋白抗体、抗核抗体、抗心磷脂抗体、抗核小体抗体等多种自身抗体阳性，临床特征为皮肤黏膜、肌肉骨骼、消化系统、血液系统、神经系统、呼吸循环系统及泌尿系统等多器官多系统受累。约60%的SLE患者会出现肾脏受累，发展为狼疮性肾炎(lupus nephritis，LN)后，10%～15%的患者进展至终末期肾脏病，并需要血液透析，严重影响患者的生活质量和预后[1]。相关研究显示，SLE患者的5年、10年生存率分别为94%和89%[2]，狼疮肾损害则是患者最常见的死亡原因和死亡的独立危险因素，出现肾脏损害者的5年生存率仅为87%[3]。因此，早期诊断和早期治疗尤为重要，以降低疾病危害，使患者获益。本文采用自身对照的临床试验方案，回顾性分析笔者所在医院环磷酰胺(CTX)联合泼尼松诱导治疗的LN患者的临床资料，探讨该治疗方式的治疗效果，现报道如下。, http://www.100md.com(李鎛江 肖友文 董建华 何玲 潘红霞)
【关键词】 环磷酰胺 泼尼松 狼疮性肾炎
doi：10.14033/j.cnki.cfmr.2020.23.010 文献标识码 B 文章编号 1674-6805(2020)23-00-03
Clinical Efficacy of Cyclophosphamide Combined with Hormone Induction in the Treatment of Lupus Nephritis/LI Bojiang， XIAO Youwen， DONG Jianhua， HE Ling， PAN Hongxia. //Chinese and Foreign Medical Research， 2020， 18(23)： -30
[Abstract] Objective： To evaluate the efficacy of Cyclophosphamide (CTX) combined with Prednisone in the induction treatment of lupus nephritis (LN). Method： Sixty-two LN patients admitted in Leshan People’s Hospital from September 2016 to June 2018 were selected. All patients were treated with CTX shock combined with Prednisone induction. Systemic lupus erythematosus disease activity index (SLEDAI)， 24 h urine protein， peripheral blood leukocyte， hemoglobin， platelet， total protein， albumin， urea， creatinine， uric acid， complement C3 and C4 were observed before and after treatment. Curative effect was evaluated. Result： One month after treatment， peripheral blood leukocyte， hemoglobin， albumin， complement C3， 24 h urine protein and SLEDAI score were significantly improved compared with those before treatment (P<0.05). The total effective rate was 12.9%. Six months after treatment， total protein and complement C4 were significantly improved compared with those before treatment (P<0.05). At six months after treatment， hemoglobin， total protein， albumin， complement C3， 24 h urine protein， and SLEDAI score were significantly improved compared with one month after treatment (P<0.05). The total effective rate was 70.96%. However， there were no significant improvement in platelet， urea， creatinine and uric acid after one month and six months (P>0.05). Conclusion： CTX combined with Prednisone induction treatment for LN is effective and worthy of clinical application.
[Key words] Cyclophosphamide Prednisone Lupus nephritis
First-author’s address： Leshan People’s Hospital， Leshan 614000， China
系統性红斑狼疮(systemic lupus erythematosus，SLE)是一种复杂的、病因未明的异质性自身免疫性疾病，好发于育龄女性，血清学特征为抗双链DNA抗体、抗Smith抗体、抗组蛋白抗体、抗核抗体、抗心磷脂抗体、抗核小体抗体等多种自身抗体阳性，临床特征为皮肤黏膜、肌肉骨骼、消化系统、血液系统、神经系统、呼吸循环系统及泌尿系统等多器官多系统受累。约60%的SLE患者会出现肾脏受累，发展为狼疮性肾炎(lupus nephritis，LN)后，10%～15%的患者进展至终末期肾脏病，并需要血液透析，严重影响患者的生活质量和预后[1]。相关研究显示，SLE患者的5年、10年生存率分别为94%和89%[2]，狼疮肾损害则是患者最常见的死亡原因和死亡的独立危险因素，出现肾脏损害者的5年生存率仅为87%[3]。因此，早期诊断和早期治疗尤为重要，以降低疾病危害，使患者获益。本文采用自身对照的临床试验方案，回顾性分析笔者所在医院环磷酰胺(CTX)联合泼尼松诱导治疗的LN患者的临床资料，探讨该治疗方式的治疗效果，现报道如下。, http://www.100md.com(李鎛江 肖友文 董建华 何玲 潘红霞)