大剂量免疫球蛋白对系统性红斑狼疮治疗作用的临床研究

目的　观察大剂量静脉滴注免疫球蛋白 ( Iv Ig)治疗系统性红斑狼疮 ( SL E)的作用。方法　采用分组对照研究 ,对比不同治疗方案对 SL E血清学指标、临床表现及整个疾病活动度 ( SL EDAI)的影响及疗效 :对照组口服 1mg· kg- 1 / d)强的松 +静脉滴注 0 .8～ 1.0 g/ ( 3～ 4)周环磷酰胺 ,其余 3组除给予相同剂量的强的松和环磷酰胺外 ,分别给予 Iv Ig( 2 0 g/ d)连续 3天、甲基强的松龙 ( MP)冲击 ( 1g/ d)连续 3天及 Iv Ig+ MP冲击。结果　 1联合应用大剂量 Iv Ig及 MP冲击治疗较单纯应用 MP冲击可更显著降低 SL EDAI( P<0 .0 5 ) ;2 Iv Ig、MP冲击、Iv Ig+MP冲击联用组血小板达高峰时间分别为 ( 6 .2± 4.4)、( 7.3± 4.9)、( 3.8± 2 .4)天 ,均较对照组明显缩短 ,后者为( 31.0± 17.8)天 ,P<0 .0 1。 Iv Ig+ MP冲击联用组血小板达高峰时间亦显著低于单纯 MP冲击组 ( P<0 .0 5 )。 Iv Ig、MP冲击、Iv Ig+ MP冲击 3组血小板计数峰值分别为 ( 175 .1± 89.2 )× 10 9/ L ,( 12 6 .8± 10 7.4)× 10 9/ L及 ( 12 8.4±78.6 )× 10 9/ L ,血小板计数升高水平均显著高于对照组 ( P<0 .0 5 )。 3对于狼疮肾炎及其他的血清学改变 ,这几组治疗方案无明显差别。结论　 Iv Ig对控制 SL E疾病活动度及 SL E继发血小

High dose intravenous immunoglobulins in the treatment of systemic lupus erythematosus

Objective　To study the effect of high dose intravenous immunoglobulins(IvIg) in the treatment of systemic lupus erythematosus(SLE).Methods　A grouping-control study was undertaken to assess clinical and serological response and to examine the reduction of overall disease activity (SLEDAI) in these SLE patients.Results　①A combination of high dose IvIg and methylprednisolone (MP) can reduce SLEDAI more significantly than high dose MP alone (P＜0.05);②For SLE-associated thrombocytopenia,high dose IvIg or MP can significantly shorten the time to reach a peak platelet count,which was 6.2±4.4 days and 7.3±4.9 days respectively in comparison with oral prednison 1mg*kg-1/d,which was 31.0±17.8 days.If high dose IvIg in combination with MP,the time was even shorter 3.8±2.4 days.The elevation of platelet count in groups receiving IvIg,bolus MP and IvIg plus bolus MP were significantly higher than in group receiving oral prednisone therapy (P＜0.05).③For lupus nephritis and other serological variables,there was no difference among these groups receiving different therapies.Conclusions　High dose IvIg is a useful therapy in improving SLE-associated thrombocytopenia and in controlling disease activity.