自身骨髓移植治疗系统性红斑狼疮初探

目的 探讨自身骨髓移植（ABMT）治疗系统性红斑狼疮（SLE）的临床效果。方法 选迁延不愈的SLE患者3例，硬膜外麻醉下，在髂后上棘取骨髓造血干细胞，4℃保存。预处理方案：2例为环磷酰胺120mg/kg，马法兰140mg/m^2；1例为环磷酰胺120mg/kg加VP-161.0g/m^2，预处理后回输骨髓造血干细胞，粒细胞刺激因子（G-CSF）协助造血及免疫重建。结果 移植后3例患者临床症状均缓解，2例免疫球蛋白降低10g/L左右，补体升高，自身抗体大部分转阴，例2皮肤病理显示原有的组织损伤减轻或消失，心肌肥厚及心包积液消失，例3移植后2周心磷脂抗体转阴，24h尿蛋白定量移植前8.50g，移植3个月后减少至2.43g。结论 （1）ABMT治疗SLE近期疗效显著。（2）疗效机制可能与预处理后组织中免疫病理细胞的减少，免疫球蛋白降低，自身抗体量的下降有关。

A pilot study in treatment of systemic lupus erythematosus by autologous bone marrow transplant

OBJECTIVE: To explore the clinical effect for treatment of SLE by autologous bone marrow transplantation(ABMT). METHODS: Three patients with refractory SLE were chosen. BM stem cells were harvested from the posterior superior iliac crests under epidural anesthesia and preserved in 4 degrees C. BM stem cells were reinfused after conditioned by CTX (120 mg/kg) and malphalan (140 mg/m(2)) or VP-16 (1.0 g/m(2)). G-CSF was used to help hematopoietic and immunologic reconstitution. RESULTS: These three patients had clinical remission after transplantation; the levels of immunoglobulins declined and complements rose up. Most of the auto-antibodies turned negative. Skin pathology in case 2 showed that the former tissue injury alleviated or disappeared. Moreover, myocardial hypertrophy and pericardial effusion also disappeared. CONCLUSIONS: (1) ABMT is obviously effective for SLE.The duration of remission remains to be decided in long-term follow up. (2) Mechanisms of improvement are possibly related to decrease of immunologic pathological cells in tissues after conditioning, reduction of the level of immunoglobulins and drop of the quantity of auto-antibodies.