甲泼尼龙脉冲联合吗替麦考酚酯治疗儿童系统性红斑狼疮临床疗效分析

摘要

目的:探讨甲泼尼龙脉冲(MDP)联合吗替麦考酚酯(MMF)治疗儿童系统性红斑狼疮(SLE)的疗效及不良反应.方法:选择16例临床诊断为 SLE、狼疮性肾炎(LN)、病理分级均为Ⅳ型弥漫性球性增生性肾小球肾炎的患儿,其中7例采用 MDP联合 MMF治疗,冲击间歇期口服小剂量糖皮质激素(GC),作为脉冲治疗组;9例采用口服 GC移行减量治疗,作为传统治疗组.疗效评价系统为狼疮疾病活动指数(SLEDAI),分析2组患儿体质量指数(BMI)、眼压(IOP)、甘油三酯(TG)、空腹血糖(FBG)、血压(BP)和血钙(Ca),比较2组患儿治疗1年内的疗效及不良反应.结果:治疗后脉冲治疗组SLEDAI评分、补体C3和补体C4水平、24 h尿蛋白定量均优于传统治疗组,其中治疗后3和6个月 SLEDAI评分2组间比较差异有统计学意义(P0.05).治疗后脉冲治疗组患儿收缩压(SBP)及舒张压(DBP)高于传统治疗组,但差异无统计学意义(P>0.05).2组患儿均未发生消化道溃疡、出血、穿孔,胰腺炎和心血管事件(如心律失常)等并发症.结论:与传统治疗方法比较,MDP联合 MMF治疗 SLE可早期快速控制症状,减轻脏器损害.以治疗1年为观察截点,其疾病活动度低于传统治疗,疗效优于口服 GC移行减量联合免疫抑制剂治疗.且 GC相关不良反应更少.%Objective:To investigate the efficacy and side effects of combination of methylprednisolone pulse (MDP)and mycophenolate mofetil(MMF)in the treatment of systemic lupus erythematosus(SLE)in the children.Methods:A total of 16 cases of children with SLE,lupus nephritis(LN)and type Ⅳ diffuse glomerular mesangial proliferative glomerulonephritis diagnosed by pathology were selected.Among them 7 cases were given MDP combined with MMF,and received intermittently oral small dose of corticosteroids(GC),and they were used as pulse therapy group;9 cases were given oral GC and transitional reduction,and they were used as traditional therapy group.SLEDAI was used for the evaluation of the curative effect,and body mass index(BMI),blood pressure(BP),intraocular pressure(IOP),triglycerides(TG),fasting blood glucose(FBG)and serum calcium (Ca)were analyzed during the treatment of 1 year and then the efficacies and side effects of the children in two groups were compared.Results:The SLEDAI scores,levels of complements C3 and C4,24 h urinary protein outcome of the children in pulse therapy group were better than those in traditional therapy group;the differences in SLEDAI scores were statistically significant after treating for 3 and 6 months between two groups(P0.05).The SPB and DBP of the patients in pulse therapy group were higher than those in traditional therapy group,but the differences were not statistically significant(P>0.05).At the same time,gastrointestinal ulcers,bleeding,perforation, pancreatitis,cardiovascular events (such as cardiac arrhythmias)didn't occur in two groups. Conclusion:Compared with traditional therapy,the combined treatment of MDP and MMF can control the symptoms of SLE early and rapidly,and reduce the viscera damage.To choose 1 year after treatment as observation point,its disease activity is lower than the traditional therapy,and the curative effect is better than oral GC transitional reduction with immunosuppressant therapy.The GC-related side effects are lower than traditional therapy.