滋肾化毒饮联合环磷酰胺对狼疮性肾炎患者外周血淋巴细胞Fas、FasL、Bcl-2表达的影响及临床疗效观察

目的:观察滋肾化毒饮联合间断性环磷酰胺(CTX)静脉冲击疗法对活动期狼疮性肾炎(LN)患者外周血淋巴细胞(PBL)凋亡调控因子及临床指标的影响.方法:将活动性LN患者40例,随机分为治疗组和对照组,每组各20例.治疗组予滋肾化毒饮联合间断性CTX静脉冲击疗法,对照组予间断性CTX静脉冲击疗法.观察治疗3个月前后的PBL的Fas、FasL、Bcl-2表达及临床指标变化,Fas、FasL、Bcl-2用免疫组化法测定.结果:治疗后两组Fas、FasL及治疗组Bcl-2表达下调(P＜0.05),而Fas、FasL表达下调幅度大于对照组(P＜0.05).治疗组SLEDAI、24 h尿蛋白、Hgb、Ccr、C3指标的改善优于同期对照组(P＜0.05).治疗组肝功能受损、白细胞减少、舌苔厚腻、失眠、痤疮发生率明显少于对照组(P＜0.05).结论:调控Fas、FasL介导的凋亡可能是CTX、激素、滋肾化毒饮有效治疗活动狼疮性肾炎机制之一.

Effects of Zishenhuadu Formula Plus Western Medicine on the Expression of Fas、FasL and Bcl - 2 of PBL in Patients with Lupus Nephritis

Objective:To evaluate the changes in the expression of Fas,Fas ligand (FasL) and Bcl-2 in the peripheral blood lymphocytes(PBL) and the clinical efficacy in active lupus nephritis(LN)treated with Zishenhuadu Formula(ZF) plus cyclophosphamide (CTX) pulse therapy(ZFCT).Methods:40 patients were randomly divided into the control group and treatment group. All patients received steroid and intermittent intravenous cyclophosphamide pulse therapy. The treatment group received ZF therapy as well. SLE Disease Activity Index (SLEDAI) score was assessed,and clinical data and expression of Fas, FasL and Bcl-2 in PBL were examined monthly for 3 months. The expressions of Fas, FasL and Bcl-2 were examined by immunohistochemical staining.Results:ZFCT significantly decreases the expression of Fas and FasL in treatment group and improved the results of clinical data, including SLEDAI,24-h urinary protein, ALB,Hb,Ccr and C3. It had less toxicity.Conclusion:The regulation of Fas and FasL is a novel target for the therapy of lupus nephriris.