糖皮质激素+环磷酰胺+他克莫司联合治疗Ⅲ+Ⅴ、Ⅳ+Ⅴ型狼疮性肾炎的临床研究

摘要

Objective To explore the efficacy and safety of glucocorticoids+cyclophosphamide+tacrolimus capsules (GC+CTX+FK506) in the treatment of patients with type Ⅲ+V and Ⅳ+Vlupus nephritis. Methods The 31 cases with first diagnosis as systemic lupus erythematosus (SLE) with type Ⅲ+V and Ⅳ+Vlupus nephritis (LN) were selected, then divided into group A (CTX+GC) with 16 cases and group B (FK506+CTX+GC) with 15 cases. The group A received CTX+GC during treatment, group B received GC+CTX+FK506 for the first three months, and received FK506+GC for the last three months. The patients were followed up once monthly to observe the efficacy and safety,the efficacy was analysed after 6 months. Results After treatment, the total efficacy in group B was significantly higher than group A (86.7%vs.50.0%, P<0.05). The 24 h urine protein of group B was lower than group A(P<0.05). The plasma albumin of group B was higher than group A (P<0.05). After treatment, the systemic lupus erythematosus disease activity index (SLEDAI) in two groups were lower and C3 level was higher than those pre-treatment(P<0.05), but there was no significant difference in above indicators between two groups. There was one case menelipsis in group A, and one case with transient increasing of creatinine. Conclusion The FK506+CTX+GC could reduce urine protein sifnificantly compared with CTX+GC without serious adverse reaction.%目的 观察糖皮质激素(glucocorticoids,GC)、环磷酰胺(cyclophosphamide,CTX)、他克莫司胶囊(FK506)联合治疗Ⅲ+V型和Ⅳ+V型狼疮性肾炎(lupus nephritis,LN)的疗效和安全性.方法 选取初次诊断为系统性红斑狼疮(systemic lupus erythematosus,SLE)并经肾穿刺活检病理诊断为Ⅲ+V型和Ⅳ+V型LN的患者31例,随机分为A组(CTX+GC组)16例,B组(FK506+CTX+GC组)15例.A组在6个月治疗期间均给予CTX+GC免疫抑制治疗,B组在前3个月的诱导期予以上述三联免疫抑制治疗,后3个月改为FK506+GC二联维持治疗.患者每月随访1次,随访过程中观察各组的疗效和安全性,6个月后分析疗效.结果 治疗后,B组总有效率为86.7%,显著高于A组的50.0%,2组比较差异有统计学意义(P<0.05).B组24h尿蛋白定量显著低于A组,血浆白蛋白显著高于A组,差异有统计学意义(P<0.05).治疗后,B组系统性红斑狼疮病情活动度(systemic lupus erythematosus disease activity index,SLEDAI)评分显著低于治疗前,C3补体含量显著高于治疗前(P<0.05),但2组间SLEDAI评分、C3补体含量、水肿例数比较差异无统计学意义.A组1例停经,B组1例血肌酐一过性升高.结论 FK506+CTX+GC三联免疫抑制治疗方案中较传统的二联免疫抑制治疗CTX+GC能较快降低尿蛋白,且未发现严重不良反应.