不同血液净化方式联合免疫抑制剂对重症狼疮肾炎的治疗观察

    Clinical observation of different ways of blood purification combined with immune inhibitors for the treatment of serious lupus nephritis

      摘要
    • 摘要: 目的 观察不同血液净化方式联合免疫抑制剂对重症狼疮肾炎（lupus nephritis，LN）患者免疫功能和临床疗效的影响。方法 将35例重症LN患者分为连续性静脉-静脉血液滤过联合常规内科治疗组（治疗组）和血液透析联合常规内科治疗组（对照组）。观察2组治疗前、后免疫功能指标抗核抗体（antinuclear antibodies，ANA）滴度、抗ds-DNA抗体、补体C3的变化，比较2组患者治疗前、后红细胞沉降率（erythrocyte sedimentation rate，ESR）、血肌酐（SCr）、尿蛋白定量的变化，并对2组患者的治疗效果及肾活检病理结果进行统计学比较。结果 入院第一天2组患者的ANA滴度、抗ds-DNA抗体、补体C3、ESR、SCr、尿蛋白定量各指标间差异均无统计学意义（P>0.05）。2组治疗1个月后 ANA、抗ds-DNA、ESR、SCr、尿蛋白定量水平均明显下降，与自身治疗前比较，差异有统计学意义（P<0.05）。治疗组与对照组比较，ANA、抗ds-DNA、ESR、SCr水平改善更为显著（P<0.05），而尿蛋白定量则无明显差异（P>0.05）。2组治疗1个月后补体C3水平升高，治疗组与自身治疗前比较，治疗后2组比较，差异均有统计学意义（P<0.05）。2组间肾活检病理活动性指数、慢性化病理指数以及肾小管间质病变评分差异无统计学意义（P>0.05）。治疗组较对照组透析治疗天数缩短，先脱离透析，治疗6个月后有效率升高。结论 连续性静脉-静脉血液滤过联合免疫抑制剂治疗可改善重症LN患者的免疫相关指标，具有较好的临床疗效，与普通血液透析治疗比较，治疗时间缩短，较早脱离透析，有利于患者肾功能恢复，且病情更为稳定。

       

      Abstract: Objective To observe the immune function and clinical curative effect of the different ways of blood purification combined immunosuppressor for the treatment of patients with serious lupus nephritis.Methods 35 patients diagnosed with serious lupus nephritis were divided into continuous veno-venous hemofiltration(CVVH)+conventional medical treatment group(treatment group) and hemodialysis(HD)+conventional medical treatment group(control group). The changes in ANA titer, anti-ds-DNA antibodies, C3, erythrocyte sedimentation rate (ESR), serum creatinine (SCr) and 24-h urinary protein quantity were compared between the two groups before and after treatment. The therapeutic effect and pathological changes of the renal biopsy were statistically compared between two groups.Results The ANA titer, anti-ds-DNA antibodies, C3, ESR, SCr and 24-h urinary protein quantity had no statistically significant difference between the two groups on the first day after admission (P>0.05). After treatment for 1 month, the ANA titer, anti-ds-DNA antibodies, ESR, SCr and 24-h urinary protein quantity in the two groups were decreased significantly as compared with those pre-treatment (P<0.05). There was significant difference in the ANA titer, anti-ds-DNA antibodies, ESR and SCr between two groups (P<0.05), but there was no significant difference in the 24-h urinary protein quantity (P>0.05). After treatment for 1 month, C3 levels were elevated, and there was significant difference in the treatment group before and after treatment, and between two groups(P<0.05). The respective index(AI), chronic index(CI) and tubulointerstitial lesions(TIL) scores had no statistically significant difference between the two groups. The dialysis days were shorter, and the treatment efficiency after 6 months was higher in the treatment group than in the control group.Conclusions CVVH therapy can improve the patient's immune indexes, has good clinical efficacy, compared with ordinary HD therapy treatment time shortened, the earlier from dialysis, could help patients with renal function recovery, and the illness is more stable.

       

      • HTML全文
      • 参考文献(16)
      • 相关文章
      • 施引文献
    • 资源附件(0)

    /

    返回文章
    返回