DNA免疫吸附治疗狼疮性肾炎的临床观察

目的观察DNA免疫吸附柱对狼疮肾炎患者的临床疗效。方法选择32例活动性狼疮肾炎患者,随机分为常规治疗组和免疫吸附组各16例。常规治疗组应用糖皮质激素（甲泼尼龙、泼尼松龙）及免疫抑制剂（环磷酰胺）治疗,免疫吸附组在常规治疗组的基础上,予以DNA免疫吸附柱进行血液吸附,每半月1次,连续6次。治疗前及免疫吸附末次治疗后,分别收集患者血标本,测定抗核抗体（ANA）、抗双链DNA抗体（ds-DNA）的清除效果及对患者血常规、血沉、免疫球蛋白、补体、肾功能等影响程度,并观察记录临床表现情况。结果DNA免疫吸附治疗后患者的症状和体征均明显改善;ANA抗体滴度吸附后明显下降1：2000及1：300,P〈0.001];抗ds-DNA抗体吸附后明显下降（36.5±10.4）IU/ml及（19.4±10.3）IU/ml];免疫球蛋白显著下降（P〈0.05）;血常规、血沉、补体等无明显影响。结论DNA免疫吸附治疗狼疮性肾炎特异性强,毒副反应较少,能明显改善临床症状,可能成为狼疮性肾炎多靶点疗法新的联合治疗手段。

Clinical observation of DNA immunoadsorption for the treatment of lupus nephritis

Objective To observe clinical effect of DNA immunoadsorption for the treatment of lupus nephritis. Methods We selected 32 patients with active lupus nephritis, and divided them equally into conventional treatment group and immunoadsorption group. For conventional treatment group, glucocorticoids （prednisolone） and immunosuppressive drugs （cyclophosphamide） were used; for immunoadsorption group, blood DNA immunoadsorption therapy was performed once half a month for 6 times in addition to the conventional therapy. Blood samples were collected before and after immunoadsorption to evaluate its clearance to antinuclear antibody （ANA） and anti-double-stranded DNA antibody （anti-ds-DNA）, and its effect on blood routine examinations, erythrocyte sedimentation rate, immunoglubulins, complements and renal function. Clinical presentations were also recorded. Results In immunoadsorption group after the treatment, symptoms and signs improved significantly, ANA and anti-ds-DNA decreased remarkably for ANA, from 1：2000 to 1：300, P 〈 0.001; for anti-ds-DNA, from （36.5 ±10.4） to （19.4 ± 10.3）IU/ml）, immunoglobulins also decreased significantly （P 〈 0.05）, but blood routine examinations, erythrocyte sedimentation rate and complements remained unchanged. Conclusions DNA immunoadsorption is effective for the treatment of lupus nephritis. It improves clinical symptoms with less sideeffects, and may become a new approach for the treatment of lupus nephritis.