雷公藤多苷联合激素治疗系统性红斑狼疮的效果及其对单核细胞糖皮质激素受体的影响

摘要

Objective To observe the clinical efficacy of tripterygium glycosides( TG) combined with glucocorticoid( GC) therapy on systemic lupus erythematosus( SLE) and the expression of glucocorticoid receptor( GR) in peripheral blood mononuclear cell( PBMC) . Methods Thirty female patients with SLE were randomly divided into treatment group and control group,with 15 cases in each group.The patients in two groups were treated with GC,and in the treatment group were treated with TG additionally.The treatment lasted for 30 days in two groups.The systemic lupus erythematosus disease activity index( SLEDAI) score and 24-hour urine protein level were determined in two groups before and after treatment.Immunohistochemistry and Western Blot were used to detect the GR expression in PBMC in two groups before and after treatment.Results After treatment,the SLEDAI score and 24-hour urine protein level of the patients in two groups significantly decreased compared with those before treatment(P<0.05),and the decrease in the treatment group was more significant(P<0.05).The GR expression increased in the treatment group after treatment(P<0.05),but in the control group decreased(P<0.05).Conclusion The clinical efficacy of TG combined with GC therapy is superior to that of routine GC therapy,which might be associated with the role of TG in up-regulating the GR expression or down-regulating the GR expression by GR inhibition.%目的：观察雷公藤多苷联合糖皮质激素治疗系统性红斑狼疮（ SLE ）的疗效及其对患者外周血单核细胞（ PBMC）糖皮质激素受体（ GR）表达的影响。方法30例女性SLE患者随机分为治疗组和对照组，每组15例，两组均给予泼尼松治疗，治疗组加用雷公藤多苷，疗程均为30 d。观察两组治疗前后系统性红斑狼疮活动度（ SLEDAI）评分及24 h尿蛋白量；使用免疫组化及Western Blot检测两组治疗前后 PBMC中GR表达情况。结果治疗后两组患者 SLEDAI评分及24 h尿蛋白量均较治疗前降低（P＜0．05），而治疗组降低更明显（P＜0．05）。治疗后治疗组患者GR表达升高（P＜0．05），而对照组表达下降（ P＜0．05）。结论雷公藤多苷联合糖皮质激素治疗SLE的疗效优于常规激素疗法，这可能是与雷公藤多苷具有提升GR表达或抑制激素下调GR表达的作用有关。