不同免疫抑制方案对狼疮肾炎患者预后的影舷

目的探讨效益/风险比更佳的狼疮肾炎(LN)治疗方案.方法前瞻性随访、观察单用激素泼尼松、泼尼松+环磷酰胺(CTX)和联用中药(泼尼松+CTX+中药)3种方案治疗的LN病人的临床和实验室资料.结果372例LN病人,随访年限中位数为5.95年,共有115例病人死亡,死亡的主要原因是并发感染.三组病人的治疗初始临床特征差异无显著性,随访终点时临床特征包括尿蛋白水平、感染发生率、氮质血症的发生率及总体病死率三组间差异均有显著性(P均＜0.05).三组病人存活率的非参数乘积限估计(Kaplan-meier)分析显示5年和10年存活率三组间两两比较,差异有显著性(P＜0.05);三组病人的生存曲线的Log-rank时序分析显示三组间两两差异有显著性(P＜0.05).结论采用激素、CTX和中药联用方案治疗LN,效益/风险比最佳.

Effects of different immunosuppressive protocols on prognosis of lupus nephritis patients

Objective To explore treatment protocols for lupus nephritis (LN) with best effect/risk ratio. Methods The clinical and laboratory data of LN patients treated with glucocorticoid only(Pred), glucocorticoid plus cyclophosphamide (Pred+ CTX) or glucocorticoid plus cyclophosphamide and Chinese medicines (Pred+ CTX+Ch) were followed prospectively. Results Three hundred and seventy-two cases of LN patients were followed. 115 cases died, in which 61cases (53%) died from severe infections. The initial clinical characteristics were not significantly different among the three treatment groups, but there was a great difference in urine protein level, infection episodes, azotemia episode and general death rate among the three treatment groups at the end of the followup. Kaplan-meier test showed a marked difference in 5 and 10 years survival rates among the three treatment groups. Log-rank test showed that there was a significant difference in survial curves among the three groups. Conclusions Pred+CTX+Ch is the best of the three treatment protocols, and has the best effect/risk ratio.