激素联合来氟米特治疗狼疮性肾炎疗效的观察

目的 了解来氟米特治疗Ⅳ型狼疮性肾炎的临床效果、安全性和不良反应.方法 59例狼疮性肾炎患者的肾活组织检查(简称活检)显示为狼疮性肾炎,应用来氟米特联合糖皮质激素治疗6个月.用药期间监测血、尿常规、24 h尿蛋白定量、肝、肾功能、抗核抗体及抗双链抗体滴度、红细胞沉降率和补体C3等,6个月后行疗效和安全性的评价.结果 来氟米特治疗狼疮性肾炎尿蛋白缓解率为72.4%,高于环磷酰胺冲击治疗缓解率(57%),狼疮性肾炎活动性指标缓解率也高于后者.结论 来氟米特联合糖皮质激素治疗能有效地控制狼疮活动且不良反应轻,耐受性好.     

来氟米特与霉酚酸酯治疗狼疮肾炎患者的临床疗效比较

目的探讨来氟米特与霉酚酸酯治疗狼疮肾炎的临床疗效和安全性。方法选择我科40例狼疮肾炎患者随机分为2组，即来氟米特组（A组）和霉酚酸酯组（B组），每组20例。2组均联合泼尼松治疗。对比观察2组治疗前和治疗后第3、6个月的系统性红斑狼疮疾病活动性指数（sys—temic lupus erythematosus disease activity index，SLEDAI）评分、24h尿蛋白定量、血白蛋白、血红蛋白、肾小球过滤率（eGFR）、补体C3、抗双链DNA抗体（ds-DNA）、血沉水平的变化及临床疗效，并分别记录不良反应。结果与治疗前相比，来氟米特组和霉酚酸酯组血白蛋白、血红蛋白均明显升高，24h尿蛋白定量明显降低，滤过率水平明显上升，血沉水平及ds—DNA水平明显下降，补体c3水平明显升高，能够改善肾功能及免疫指标，且2组间差异无统计学意义（P〉0．05）。来氟米特组恶心呕吐、肝功能损害、白细胞数降低、皮疹、腹泻、月经不调、高血压、感染等不良反应发生率分别为15％（3例）、20％（4例）、10％（2例）、10％（2例）、5％（1例）、15％（3例），5％（1例），5％（1例）；霉酚酸酯组恶心呕吐、肝功能损害、白细胞数降低、皮疹、腹泻、月经不调、高血压、感染等不良反应发生率分别为10％（占2例）、5％（1例）、0例、5％（占1例）、5％（占1例）、0例、0例、5％（占1例）。结论来氟米特和霉酚酸酯均能有效控制狼疮肾炎，但霉酚酸酯不良反应相对较轻。     

免疫吸附治疗狼疮性肾炎的临床观察

目的 观察免疫吸附治疗狼疮性肾炎的临床疗效.方法 选择2007年7月至2010年7月狼疮性肾炎患者29例,均有明显的血尿、尿蛋白每天＞2.0 g,血肌酐(306.28±0.12)μmol.其中14例狼疮性肾炎患者采用DNA280免疫吸附柱进行血液净化治疗,免疫吸附治疗2次,每次2 h,同时按疗程给与小剂量泼尼松(0.5 mg·kg-1·d-1)及间断环磷酰胺(6～8 g)静脉冲击治疗.另外15例患者应用传统治疗方法,给予大剂量的泼尼松(1 mg·kg-1·d-1)及间断环磷酰胺静脉冲击治疗作为对照组并进行比较.结果 免疫吸附治疗组患者好转率为79%,对照组好转率为56%,两组比较差异有统计学意义(P＜0.01).结论 免疫吸附能有效地控制狼疮性肾炎,明显改善狼疮性肾炎患者的肾功能.

Abstract：

Objective immunoadsorption treatment of lupus nephritis clinical efficacy. Methods from July 2007 to July 2010 29 patients with lupus nephritis, have significant hematuria, urinary protein per day＞ 2.0 g, serum creatinine (306.28 ± 0.12) μmol. 14 patients with lupus nephritis were treated with DNA280 immunosorbent column and blood purification therapy, immunoadsorption therapy 2 times 2 h, while treatment given by a small dose of prednisone (0.5 mg·kg-1·d-1) and intermittent cyclophosphamide (CTX, 6-8 g) intravenous pulse therapy. Another 15 patients were treated with conventional therapy, high dose of prednisone (1 mg · kg-1 · d-1) and CTX intermittent intravenous pulse therapy as a control group and compared. Results improved in patients treated with immunoadsorption was 78.57% in the control group improvement was 56.25% (P ＜ 0.01). Conclusion The adsorption can effectively control the immune lupus nephritis, lupus nephritis significantly improved renal function.     

狼疮肾炎患者血清和尿白细胞介素-18水平检测及其临床意义

目的：检测狼疮肾炎(LN)患外周血清和尿液白细胞介素—18(IL—18)水平并探讨其临尿意义。方法：血清和尿液IL-18含量采用酶联免疫吸附方法(ELISA)。结果：LN组血清IL—18水平显高于正常对照组(P＜0、01)，活动期LN血清IL—18水平显高于缓解期患(P＜0．01)3LN组尿IL—18水平显高于正常对照组(P＜0．05)，活动期LN患尿IL—18水平显高于缓解期患(P＜0．05)。LN患血清IL—18水平与SLEDAI、抗dsDNA抗体成正相关关系，与补体C3呈负相关关系，而与血白蛋白、血肌酐无相关关系；活动期LN患尿IL—18水平与狼疮肾组织活动性指数(AI)、24h尿蛋白排泄量均呈正相关关系。结论：LN血清和尿IL—18水平显增高，IL—18可能在LN的病理生理过程中起重要作用。LN血清和尿IL—18水平均与狼疮病情活动密切相关，可作为判断狼疮疾病活动性的候选参考指标。     

Association of serum renalase with disease activity in lupus nephritis

Objective To investigate the relationship between serum renalase and disease activity in lupus nephritis (LN). Methods Total of 70 patients with LN and 35 healthy volunteers admitted in Renji Hospital of Shanghai Jiao Tong University from March 2012 to March 2013 were enrolled in the study. LN patients were classified into two groups according to their systemic lupus erythematosus disease activity index (SLEDAI) scores: patients with SELDAI score lower than 8 were defined as inactive LN while others were defined as active LN. Serum samples were collected after an overnight fast and serum renalase level was determined by ELISA. Twenty active LN patients were followed up for six-months, and serum renalase was also determined before and after treatment. The differences in serum renalase level between LN patients and healthy controls were assessed, as well as the association of serum renalase with disease activity in LN. Results In 70 LN patients, 35 were classified active LN while others were inactive LN. Serum renalase level was significantly higher in LN patients than than in healthy controls (P﹤0.01). Moreover, active LN patients had higher serum renalase level compared to patients with inactive LN (P﹤0.01). Active LN patients had higher 24-hour urine protein excretion, erythrocyte sedimentation rate and anti-dsDNA antibody titers than inactive LN patients. Serum albumin was lower in inactive LN patients compared to active LN patients. There were no differences in gender, age, blood pressure and C-reactive protein between the two groups. Serum renalase levels were positively correlated with SLEDAI, 24-hour urine protein excretion, ds-DNA and ESR but inversely correlated with serum albumin and C3. Renalase amounts decreased significantly after six-months of standard therapy. The performance of renalase as a marker for diagnosis of active LN was 0.894 with a cutoff value of 66.67 mg/L. Logistic regression showed that serum renalase (OR=1.078, 95%CI 1.031-1.120, P=0.001) and complement C3 (OR=0.022, 95%CI 0.002-0.326, P=0.005) is independent indicators for disease activity in LN. Conclusions Serum renalase level was correlated with disease activity in LN. Serum renalase may serve as a potential indicator for disease activity in LN.     

来氟米特治疗肾病综合征表现的紫癜肾临床观察

目的观察激素联合来氟米特治疗表现为肾病综合征的紫癜肾,探讨来氟米特的疗效及安全性。方法选择过敏性紫癜性肾炎患者38例,男20例,女18例,平均年龄（26．2±10．6）岁,均符合肾病综合征诊断标准,随机分为来氟米特治疗组和环磷酰胺对照组。来氟米特治疗组19例,给予口服来氟米特50mg／d,3d后20mg／d维持,激素用量1mg／（kg·d）、服8周后减量;环磷酰胺对照组19例采用环磷酰胺,每半月冲击一次,总量达到150mg／kg,激素服药方法同治疗组。观察治疗后各组患者24h尿蛋白定量、尿沉渣红细胞数目、血浆白蛋白水平。结果用药后3个月及6个月两组24h尿蛋白定量较治疗前均显著下降,血浆白蛋白水平显著升高,尿沉渣红细胞计数明显减少（P〈0．05）。3个月后来氟米特治疗组较环磷酰胺对照组疗效差异无显著性（P〉0．05）,但6个月后疗效治疗组较对照组有明显统计学意义（P〈0．05）。结论来氟米特是治疗表现为肾病综合征的紫癜肾的一种安全有效的药物,优于环磷酰胺。     

来氟米特治疗以肾病综合征为主要表现的IgA肾病的对照研究

目的探讨来氟米特治疗以肾病综合征为主要表现的IgA肾病患者的疗效及安全性。方法60例患者随机分为治疗组和对照组,每组30例。治疗组应用泼尼松联合来氟米特治疗;对照组应用泼尼松联合环磷酰胺冲击治疗。观察治疗前后24h尿蛋白定量,血浆白蛋白,肝、肾功能及治疗后药物的不良反应。结果治疗组与对照组的总有效率分别为86．7％和83．3％;不良反应总发生率分别为30．0％和73．3％。结论来氟米特联合泼尼松治疗以肾病综合征为主要表现的IgA肾病疗效可靠,不良反应发生少,为临床治疗提供的一种新的方法。     

来氟米特对Ⅳ型及Ⅴ型狼疮肾炎的诱导维持治疗

目的 观察来氟米特诱导和维持治疗Ⅳ型及Ⅴ型狼疮肾炎（LN）的疗效及安全性。方法 单中心前瞻性临床研究。选取1个月内经病理证实的Ⅳ型及Ⅴ型狼疮肾炎患者，在使用激素的基础上随机入组分别使用来氟米特(口服30 mg/d，LEF组)或环磷酰胺（静1 g/月，CTX组）。6个月后，维持方案为LEF组续用LEF 20 mg/d，CTX组续用CTX 1 g/3月，两组泼尼松均使用5~10 mg/d。评价治疗的安全性和有效性。结果 共40例患者进入试验，其中LEF组19例，CTX组21例；LEF组17例、CTX组18例完成了诱导期治疗。LEF组诱导治疗总有效率达88.2％，完全缓解率为52.9％；CXT组治疗总有效率为72.2％，完全缓解率为44.4％；两组间差异无统计学意义。缓解的患者中，LEF组有7例进入维持期治疗，随访时间（18.6±6.5）月，未出现蛋白尿复发，其中3例进行了重复肾活检，结果显示肾脏病理类型均由重转轻，活动性指数下降，但慢性指数有所上升。CTX组有11例进入维持期治疗，随访时间（25.1±9.6）月，其中有3例在随访中蛋白尿复发。LEF组发生不良反应14例次，主要是感染，以带状疱疹多见。环磷酰胺组发生不良反应18例次，主要为感染和月经不调，组间比较差异无统计学意义。结论 来氟米特联合激素诱导及维持治疗Ⅳ型及Ⅴ型LN疗效显著，患者耐受性良好。     

来氟米特对糖尿病肾病大鼠MCP-1表达的影响

目的：通过建立糖尿病肾病（DN）大鼠模型来研究来氟米特对大鼠肾脏MCP-1表达的影响,以进一步探讨来氟米特对DN大鼠的治疗作用及其机制。方法：健康雄性Wistar大鼠30只随机分为3组：对照组、DN组及来氟米特组,应用链脲佐菌素（STZ）诱导左肾切除大鼠DN模型,来氟米特组在成模后每日灌胃来氟米特5mg/kg。于实验第8周、12周末各组分别取5只动物测24h尿量及24h尿蛋白定量;心内采血测肌酐（Scr）、尿素氮（BUN）;电镜标本观察肾组织病理改变,免疫组化法检测肾组织MCP-1蛋白的表达。结果：来氟米特组大鼠尿蛋白、Scr、BUN与同期DN组相比明显减少。病理组织学观察说明来氟米特可以减轻肾脏损害。经来氟米特治疗后,MCP-1的表达减少。结论：来氟米特可减少DN大鼠肾组织MCP-1的表达,减轻肾脏损害。     

Successful treatment of class V+IV lupus nephritis with multitarget therapy

Treatment of class V+IV lupus nephritis remains unsatisfactory despite the progress made in the treatment of diffuse proliferative lupus nephritis. In this prospective study, 40 patients with class V+IV lupus nephritis were randomly assigned to induction therapy with mycophenolate mofetil, tacrolimus, and steroids (multitarget therapy) or intravenous cyclophosphamide (IVCY). Patients were treated for 6 mo unless complete remission was not achieved, in which case treatment was extended to 9 mo. An intention-to-treat analysis revealed a higher rate of complete remission with multitarget therapy at both 6 and 9 mo (50 and 65%, respectively) than with IVCY (5 and 15%, respectively). At 6 mo, eight (40%) patients in each group experienced partial remission, and at 9 mo, six (30%) patients receiving multitarget therapy and eight (40%) patients receiving IVCY experienced partial remission. There were no deaths during this study. Most adverse events were less frequent in the multitarget therapy group. Calcineurin inhibitor nephrotoxicity was not observed, but three patients developed new-onset hypertension with multitarget therapy. In conclusion, multitarget therapy is superior to IVCY for inducing complete remission of class V+IV lupus nephritis and is well tolerated.     

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.     

来氟米特联合泼尼松治疗表现为肾病综合征局灶节段性肾小球硬化的临床观察

目的观察来氟米特联合泼尼松治疗表现为肾病综合征局灶节段性肾小球硬化（focalsegmental glomerulosclerosis,FSGS）患者的疗效及安全性。方法将60例局灶节段性肾小球硬化肾病综合征患者随机分为2组：来氟米特（1eflunomicle,LEF）治疗组30例、环孢素（cyclosporinA,CsA）组30例。LEF组开始治疗后,前3d予LEF50mg／d,3d后改为维持剂量30mg／d）CsA组予以CsA1．5～2．5mg·kg-1·d-1,根据血药浓度逐渐增加剂量。2组患者同时使用泼尼松0．5mg·kg-1·d-1,并逐渐减量。观察治疗前、治疗后第4、8、12周及第6、12个月的24h尿蛋白定量、肝功能、肾功能、血脂等临床指标以及不良反应。结果LEF组30例患者均完成了一年的治疗观察,CsA组30例患者有一例因药物副反应退出治疗,其余29例患者完成了治疗。2组患者治疗后24h尿蛋白定量明显减少,血白蛋白升高,与治疗前相比,差异均有统计学意义（P〈O．05）。LEF组治疗后第6个月时总有效率70．00％（21／30）,治疗后第12个月时总有效率76．67％（23／30）;CsA组治疗后第6个月时总有效率75．86％（22／29）,治疗后第12个月时总有效率68．97％（20／29）,2组比较差异无统计学意义（P〉0．05）。LEF组不良反应轻微,患者耐受性良好。结论LEF是治疗表现为肾病综合征的FSGS患者的一种安全有效药物。     

Azathioprine/methylprednisolone versus cyclophosphamide in proliferative lupus nephritis. A randomized controlled trial

Until recently, intravenous cyclophosphamide pulses with oral corticosteroids were regarded standard therapy for proliferative lupus nephritis (LN). Azathioprine, a less toxic alternative, was never proven to be inferior. In the first Dutch lupus nephritis study (enrollment between 1995 and 2001), we randomized 87 proliferative LN patients to either cyclophosphamide pulses (750 mg/m(2), 13 pulses in 2 years) combined with oral prednisone (CY) or to azathioprine (2 mg/kg/day in 2 years) combined with intravenous pulses of methylprednisolone (3 x 3 pulses of 1000 mg) and oral prednisone (AZA). After a median follow-up of 5.7 years (interquartile range 4.1-7.2 years), doubling of serum creatinine was more frequent in the AZA group, although not statistically significant (relative risk (RR): 4.1, with 95% confidence interval (95% CI): 0.8-20.4). Relapses occurred more often in the AZA group (RR: 8.8, 95% CI: 1.5-31.8). Creatinine and proteinuria at last visit did not differ between the two treatment arms. Moreover, 88.4% of the patients in the AZA arm were still free of cyclophosphamide treatment. During the first 2 years, the frequency of remission was not different, but infections, especially herpes zoster virus infections (HZV) were more frequent in the AZA group. Parameters for ovarian function did not differ between the two groups. In conclusion, in this open-label randomized controlled trial, cyclophosphamide was superior to azathioprine with regard to renal relapses and HZV. At last follow-up, there were no differences in serum creatinine or proteinuria between the two groups. However, since our study lacked sufficient power, longer follow-up is needed to reveal putative differences.     

霉酚酸酯治疗弥漫增生性狼疮肾炎的临床观察

目的 :评估霉酚酸酯联合强的松治疗弥漫增生性狼疮肾炎的疗效及其安全性。方法 :4 6例患者随机分成 2组 ,治疗组口服霉酚酸酯加强的松 12个月 ;对照组静滴环磷酰胺加口服强的松 6个月 ,之后给予强的松和硫唑嘌呤 6个月。结果 :治疗组的 2 5个病人中的 80 %完全缓解 ,对照组中 76 %完全缓解 ,而治疗组、对照组病人部分缓解率分别为 17%和 14 %。每组各有 1个病人因副作用中断治疗 ,治疗过程中治疗组有 2 0 % ,对照组有 33%病人出现感染 (P =0 .2 9)。同时观察到仅对照组病人中出现闭经 (占病人中的 2 3% )、脱发 (19% )、白细胞减少 (10 % )及死亡(10 % )等副反应。治疗组、对照组复发率分别为 13%和 11%。结论 :对于弥漫增生性狼疮肾炎的治疗 ,霉酚酸酯和强的松联合治疗的方案与环磷酰胺和强的松治疗后序贯使用硫唑嘌呤的方案效果相同 ,而前者的副作用较少     

巨噬细胞移动抑制因子在狼疮肾炎患者血清和尿液中的表达

目的探讨巨噬细胞移动抑制因子（MIF）在狼疮。肾炎（LN）发病过程中的分子生物学机制及其在疾病进展中的作用。方法选择我院LN患者30例，用酶联免疫吸附方法测定LN患者血清和尿液MIF浓度，并将血清和尿液MIF浓度与狼疮活动指数、24h尿蛋白定量、血尿和肌酐清除率（Ccr）进行相关性分析，以20名健康体检者作对照组。结果LN患者血清和尿液MIF浓度均高于对照组（P〈（）．01）；活动期LN患者治疗后尿液MIF浓度较治疗前降低（P％0．（）1），而血清MIF浓度治疗前、后无统计学差异（P〉0．05），活动期较静止期LN患者血清和尿液MIF浓度升高（P〈0．01），LN患者血清和尿液MIF浓度与狼疮活动指数呈正相关（r分别为0．598和0．641，P〈0．01）；LN患者血清和尿液MIF浓度均与24h蛋白尿定量呈显著正相关（r分别为0．524和0．749，P〈0．01），与血尿和Ccr均无相关性（P〉0．05）。结论LN患者尿液MIF浓度明显升高，与病情活动程度相关，对于判断患者病情的活动有一定价值。     

血清趋化因子的表达水平与其狼疮肾炎血浆吸附远期疗效的关系分析

目的 探讨狼疮肾炎血浆吸附的远期疗效及其与血清趋化因子水平的关系.方法 选取行血浆吸附治疗的狼疮肾炎患者32例为研究组,均随访至少2年,检测统计患者的24h尿蛋白定量水平及其2年复发率.另选取30例同期进行健康体检者为对照组.采用酶联免疫吸附法检测2组血清趋化因子5(CCL5)、巨噬细胞炎症蛋白1α(MIP-1oα)、巨噬细胞炎症蛋白1β(MIP-1β)等趋化因子水平并分析狼疮肾炎血浆吸附患者血清趋化因子水平与其24h尿蛋白定量水平的关系.比较复发和无复发患者的血清趋化因子水平并分析其血清趋化因子水平与其复发的关系及其预测其复发的价值.结果 与对照组比较,研究组治疗前的血清CCL5、MIP-1α、MIP-1β等趋化因子水平和24 h尿蛋白定量水平均升高(P＜0.05).与治疗前比较,研究组治疗后和随访期间的血清趋化因子水平均降低(P＜0.05).研究组随访2年复发率为68.75％(22/32),且复发患者治疗前后和随访期间的血清趋化因子水平均高于无复发患者(P＜0.05).狼疮肾炎血浆吸附患者血清CCL5、MIP-1 α、MIP-1β与其24 h尿蛋白定量水平及其复发均相关(P＜0.05).且狼疮肾炎血浆吸附患者治疗前后血清趋化因子水平单独和联合预测其复发的价值良好,其中以治疗后血清趋化因子水平联合预测其复发的价值最佳.结论 血清趋化因子水平与狼疮肾炎血浆吸附远期疗效明显相关且对其复发的预测价值良好,可能作为其远期疗效评估的参考指标.     

Updates on the treatment of lupus nephritis

The treatment of lupus nephritis has changed significantly over the past decade in large part because of data from well-conducted randomized clinical trials. The concept of two phases of therapy-induction and maintenance-is widely accepted. The histopathologic classification of lupus nephritis continues to guide therapy, and treatment for all major classes of lupus nephritis has seen some shift in management during this time. New regimens using lower doses and shorter treatment durations of intravenous cyclophosphamide have been advanced to reduce toxicity without sacrificing efficacy of therapy. Mycophenolate mofetil has emerged as a viable alternative to cyclophosphamide for induction therapy of both proliferative and membranous lupus nephritis. Combination induction treatment with multiple agents has also been successful. Large controlled trials using mycophenolate mofetil and azathioprine for maintenance therapy have been performed. Here, we review recent additions to the growing body of literature on how to most effectively treat lupus nephritis with the least amount of toxicity. We discuss new treatment strategies currently being explored in clinical trials.     

Infection in children with lupus nephritis receiving pulse and oral cyclophosphamide therapy

Infection is the major complication of cyclophosphamide therapy in patients with lupus nephritis. The objectives of this study were to report and compare the rate of infection between children with lupus nephritis who had received intravenous pulse cyclophosphamide (IVCY) and those who had received oral cyclophosphamide (OCY) and to determine the risk factors for infection during treatment with cyclophosphamide in these groups. Records of nine patients who had received IVCY from the beginning [pure intravenous cyclophosphamide (PIVCY) group], 11 patients who had received prior oral cyclophosphamide and later switched to IVCY [combined intravenous cyclophosphamide (CIVCY) group] and 41 patients who had received OCY were reviewed. Infection occurred in 21 of 61 patients (34%). In the PIVCY group, four episodes of infection occurred in three of nine patients (33%). In the CIVCY group, six episodes of infection occurred in four of 11 patients (36%). In the OCY group, 18 episodes of infection occurred in 14 of 41 patients (34%). The rate of infection between these groups was not different (P=0.99). None of the following parameters were risk factors for infection: cumulative dose of cyclophosphamide, leukopenia and neutropenia. On the contrary, white blood cell (WBC) count and polymorphonuclear cell (PMN) count were significantly less in the no-infection group (P=<0.001, P<0.001, respectively), with odds ratios for leukopenia (WBCs <4,000 mm³) and neutropenia (PMNs <1,500 mm³) between the infection and the no-infection group equal to 0.18 (95%CI 0.05–0.63) and 0 (95%CI 0–0.19), respectively. Most of the patients who had infection received prednisolone at a dosage of more than 0.5 mg/kg per day (67% of the PIVCY group, 50% of the CIVCY group and 83% of the OCY group). Fatal infections occurred in two patients who had concomitant active systemic lupus erythematosus (SLE). Although lymphopenia (lymphocyte count <1,500/mm³) was not the risk factor for infection, it was observed that six of seven patients with herpes zoster had lymphopenia. Herpes zoster seemed to occur more frequently in the OCY group (15%) than in the whole IVCY group (5%), but there was no statistical difference (P=0.41). We conclude that the rate of infection in the IVCY and OCY group was not different. Infection is likely to occur in patients receiving a concomitant high dose of prednisolone. The occurrence of fatal infection in patients with active disease should be noted. No single risk factor was detected in this study.     

抗核小体抗体阳性的狼疮肾炎临床病理分析

目的 探讨抗核小体抗体(AnuA)阳性的狼疮肾炎(LN)的临床病理特征.方法 回顾分析2004至2011年我院肾穿刺活检确诊的481例LN患者的临床表现及肾脏病理.用免疫印迹法测定患者血清中的AnuA,分为阳性组(n=76)和阴性组(n=405),比较两组的流行病学、临床表现、肾脏病理、疾病活动度之间的差异.结果 阳性组男15例,女61例,男性占19.74％,年龄(27.99±10.88)岁.阴性组男45例,女360例,男性占11.11％,年龄(31.15±12.15)岁.阳性组发病年龄早且男性多见(P＜0.05);口腔溃疡、发热、贫血、低补体血症发生率、dsDNA抗体阳性率高于阴性组(P＜0.05).阳性组弥漫增生性狼疮肾炎(Ⅳ型)比例及病理活动指数(AI)评分均显著高于阴性组(均P＜ 0.05);其他病理类型比例、慢性指数(CI)评分、SLEDAI评分两组间差异无统计学意义.结论 AnuA阳性的LN具有一定的临床病理特征,可作为增生性狼疮肾炎的生物学标记.     

双重血浆滤过治疗重型系统性红斑狼疮的疗效观察

目的评价双重血浆滤过（double filtration plasmapheresis,DFPP）对合并狼疮肾炎（1u—pus nephritis,LN）的重型系统性红斑狼疮（systemic lupus erythematosus,SLE）的治疗效果。方法36例合并LN的重型SLE患者,根据治疗方法分为药物治疗组（对照组）和药物治疗＋DFPP组（DFPP组）,每组18例。观察治疗前后肾功能相关指标、免疫学指标以及系统性红斑狼疮疾病活动指数（SLEDAI）的变化情况。结果对照组和DFPP组治疗后24h尿蛋白定量、BUN、SCr、血清胱抑素C均显著下降（P〈0．05）,组间比较,DFPP组以上各项指标下降更明显（P〈0．05）。对照组和DFPP治疗组血白蛋白水平治疗前后差异无统计学意义（P〉0．05）。对照组治疗后ANA阳性率、抗ds-DNA阳性率、IgG、IgA、IgM、ESR下降（P〈0．05）,补体C3、CA升高（P〈0．05）,DFPP治疗组治疗后ANA阳性率、抗ds—DNA阳性率、IgG、IgA、IgM、ESR下降（P〈0．05）,而补体C3、C4无统计学差异（P〉0．05）。与对照组相比,DFPP组ANA和抗ds—DNA转阴率更高,IgG下降更明显（P〈0．05）。对照组与DFPP组治疗前后SLEDAI明显下降（P〈0．05）,组问比较,DFPP组下降更显著（P〈0．05）。DFPP组疗效优于对照组（P〈0．05）。结论对于合并LN的重型SLE患者,在常规药物治疗的基础上,采用DFPP可显著缓解病情。