狼疮性肾炎伴血管病变患者治疗前后血管内皮细胞损伤标记物的变化

目的探讨狼疮性肾炎伴血管病变患者治疗前后血管内皮细胞损伤标记物的变化情况和临床疗效。方法选取本院2006年1月~2010年6月收治的狼疮性肾炎伴血管病变患者76例,将采用环磷酰胺（0.75~1.00 g/m2,每月静脉滴注1次）治疗3个月的患者作为对照组（n=38）,将采用霉酚酸酯（1.5~2.0 g/d,分2次口服）治疗3个月的患者作为观察组（n=38）,分析比较两组患者治疗后的各项临床指标,主要包括可溶性血栓调节蛋白（soluble thrombo-modulin,sTM）、可溶性血管内皮细胞蛋白C受体（soluble endothelial cell protein C receptor,sEPCR）、血管病血友病因子（von willebrand factor,vWF）。结果观察组采用霉酚酸酯治疗后血管内皮细胞损伤标记物sTM、sEPCR、vWF明显低于采用环磷酰胺治疗的对照组（P〈0.05）,观察组并发症明显少于对照组,且患者满意度明显高于对照组,差异有统计学意义（P〈0.05）。结论采用霉酚酸酯治疗狼疮性肾炎伴血管病变的患者血管内皮细胞损伤标记物的变化显著,sTM、sEPCR、vWF均得到了明显改善,且对患者的副作用较小,是一种安全有效的治疗方法,值得临床推广使用。

The change of vascular disease markers between before and after treatment of patients with lupus nephritis combined with vascular lesions

Objective To investigate the change of vascular disease markers between before and after treatment of patients with lupus nephritis combined with vascular lesions and its clinical effects.Methods 76 cases of patients with lupus nephritis combined with vascular lesions in our hospital from January 2006 to June 2010 were selected,38 patients who were treated with Cyclophosphamide(0.75~1.00 g/m2,intravenous infusion once a month) for three months were divided into the control group,38 patients who were treated with Mycophenolate Mofetil(1.5~2.0 g/d,two times oral) for three months were divided into the observation group.The clinical parameters,including soluble thrombomodulin(sTM),soluble endothelial cell protein C receptor(sEPCR),von willebrand factor(vWF) of the two groups before and after treatment were analyzed and compared.Results Compared with control group,the vascular endothelial cell injury markers rate of sTM,sEPCR,vWF were significantly reduced in patients of observation group with Mycophenolate Mofetil treatment(P < 0.05).Incidence of complications in the observation group was less than that in the control group(P < 0.05).The satisfaction rate of patients in the observation group was significantly higher than that in the control group(P < 0.05).Conclusion Using Mycophenolate Mofetil in treatment of patients with lupus nephritis combined with vascular lesions can make the vascular disease markers change significantly,and sTM,sEPCR,vWF have been markedly reduced,which also has less side-effects.It is a safe and effective method for treatment and worthy of clinical application.