异基因骨髓间充质干细胞移植治疗系统性红斑狼疮11例临床分析

目的 探讨异基因骨髓问充质干细胞(MSC)移植治疗难治性系统性红斑狼疮(SLE)的疗效及安全性.方法 血缘相关供者骨髓中分离培养MSC移植治疗11例SLE患者,移植前予环磷酰胺(CTX)0.8～1.8 g,分2～3次静脉输注,输注后隔日予MSC移植,移植细胞数(1×106/kg体质量).评价患者移植前后的临床表现和实验室检查指标的改变.结果 异基因MSC移植后,11例SLE患者随访1～13个月,所有患者均无移植相关并发症.移植后1个月SLE疾病活动评分(SLEDAI)由12±5降低为6±3(11例,P＜0.01).尿蛋白定量(24 h)移植后1个月由(1989±842)mg(518～3690 mg)降低为(1118±700)mg(10例,P＜0.05);移植后2个月(2478±797)mg vs (924±659)mg,5例,P＜0.05];移植后6个月(2478±797)mg vs(522±151)mg,5例,P＜0.01].2例肾功能不全患者血肌酐轻度下降.5例低蛋白血症患者移植后1个月血清白蛋白上升(28±6)g/L vs(32±7)g/L,5例,P＜0.05].移植后1个月血清补体C3升高(0.50±0.12)g/L vs(0.75±0.10)g/L,9例,P＜0.01],抗核抗体(ANA)滴度降低.结论 异基因MSC移植治疗难治性SLE有效安全.MSC取材方便,扩增迅速,输注安全经济.异基因MSC移植治疗SLE的长期疗效评估需进一步随访观察.

Clinical analysis of allogenic bone marrow derived mesenchymal stem cells transplantation for 11 patients with systemic lupus erythematosus

Objeefive To explore the clinical efficacy and safety of allogenic bone marrow derived mesenchymal stem cells transplantation(MSCT) in patients with refractory systemic lupus erythematosus(SLE).Methods Eleven patients with refractory SLE(nine females and two males aged from 16～41 years(mean 25±8).were entailed in the study.The infcIrmed consents which were approved by the Ethics Committee of the Affiliated Drum Tower Hospital of Naniing University Medical School were obtained from all participants.Bone marrow of healthy donors were obtained and the mesenchymal stem cells(MSC)were expanded in vitro.Each patient was infused MSC 1×106/kg body weight intravenously.Before MSCT.all patients were administrated with cvclophosphamide (CTX)800～1800 mg divided by two to three days.The clinical manifestations and laboratory tests were compared before and after MSCT.Results The eleven patients were followed up for one to thirteen months after MSCT.A11 patients did not develop transplantation related complications.The systemic lupus erythematosus disease activity index (SLEDAI)score decreased from 1 1.7±5.1 to 5.6±3.4 one month after MSCT(n=11,P＜0.01).Ufine protein excretion decreased from(1989+842)mg/24 h to(1118±700)mg/24 h one month after MSCT(n=10,P=0.02).Five patients were followed up for six months and their urine protein excretion decreased significantly (522±151)mg/24 h vs (2478±797)rag/24 h.n=5.P＜0.01j.The serum albumin level of 5 patients with hypoalbuminemia increased gradually one month after MSCT (28±6)g/L vs (32±7)g/L,n=5,P＜0.05].Serum complement C3 level increased from(0.50±0.12) g/L to(0.75±0.10)g/L (n=9.P＜0.01) and their anti-nuclear antibody (ANA) titer decreased one month after MSCT.In two patients with chronic renal failure.the serum creatinine decreased gradually.Conclusion Allogenic MSCT is an effective and safe approach for the treatment of refractory SLE.However.extensive follow-up study is needed for long-term benefit evaluation.