西罗莫司联合激素治疗增殖性狼疮性肾炎疗效观察

目的比较观察西罗莫司与环磷酰胺(CTX)静脉冲击联合激素诱导治疗增殖性狼疮性肾炎(LN)的临床疗效。方法将33例经肾活检诊断为Ⅲ、Ⅳ、Ⅴ型肾功能正常的增殖性LN患者随机分为西罗莫司组17例和传统疗法组16例。西罗莫司组予西罗莫司+泼尼松治疗,传统治疗组予CTX+泼尼松治疗。比较2组治疗3个月、6个月的临床疔效及24h尿蛋白定量、血红蛋白、血清白蛋白(ALB)、血肌酐(Scr)、补体C3、补体C4、狼疮疾病活动性指数(SLEDAI)评分和血尿症、水肿、ANA阳性、抗双链DNA抗体阳性发生情况。结果西罗莫司组治疗3个月末及治疗6个月末总有效率均高于传统疗法组,差异均有统计学意义(P<0.05)。与传统疗法组比较,治疗3个月后,西罗莫司组在尿蛋白下降、血ALB升高、SLEDAI减少及水肿消退诸方面差异有统计学意义(P<0.05);在治疗6个月后西罗莫司组以上各项指标与传统疗法组比较差异有统计学意义(P<0.05)。结论西罗莫司联合激素较传统疗法能更快速有效地诱导增殖性LN缓解,安全性好,值得推广应用。

Sirolimus combined with hormone in treatment of proliferative lupus nephritis

Objective To comparative observe the clinical efficacy of sirolimus and cyclophosphamide（CTX） intravenous pulse combined with hormone in proliferative lupus nephritis （LN）. Methods 33 cases patients with proliferative LN were randomly divided into simlimus group（ 17 cases） and traditional therapy group（ 16 cases）. Sirolimus group were given sirolimus ＋ prednisone therapy, traditional therapy group received CTX ＋ prednisone therapy. Compared the effect clinical of treatment 3 months,6 months and 24h urinary protein, hemoglobin, serum albumin （ ALB）, serum creatinine （Scr）, complement C3 ,complement C4 ,lupus disease activity index （SLEDAI） score and the situation of hematuria, edema, ANA positive, anti- double stranded DNA antibodies. Results The total effective rate of of treatment 3 months,6 months in sirolimus group were higher than those in traditional therapy group, there were significant difference （ P 〈 0.05 ）. Compared with traditional therapy group, after treatment three months, sirolimus group decreased urinary protein, serum ALB increased,the SLEDAI reduced and edema aspect of the difference were statistically significant （ P 〈 0.05 ） ; After treatment 6 months, the above indicators in siroli- mus group compared with traditional therapy group, the difference were statistically significant （ P 〈 0.05 ）. Conclusion Siroli- mus combined with hormone than traditional therapy can be more quickly and efficiently induced proliferative LN ease ,the security good, should be widely applied.