免疫吸附治疗狼疮性肾炎的疗效观察

目的观察免疫吸附(IA)治疗狼疮性肾炎(LN)的临床疗效。方法应用免疫吸附对15例重症狼疮性肾炎、肾检病理类型为Ⅳ型(n=10)和Ⅴ+Ⅳ型(n=5)的患者进行治疗。100%患者入院时血清肌酐(Scr)升高平均(330.5+207.2)umol/L(]女性12例,男性3例,年龄17-42岁),观察吸附治疗前、后抗核抗体(ANA)、抗双链DNA抗体(dsDNA)、补体C3、血沉、疾病活动指数(DAI)评分、肾功能的变化情况,同时观察不良反应。结果 (1)免疫吸附治疗后患者ANA明显下降(1:1800)下降至(1∶200),P0.01],抗dsDNA抗体滴度明显下降(38.9+10.3)IU/L下降至(20.1+9.6)IU/L,P0.05]、血沉明显降低(75.0+12.0)mm/h下降至(24.0+8.0)mm/h,P0.05],补体C3明显升高(0.65+0.22)g/L升高至(0.82+0.31)g/L,P0.05];(2)免疫吸附治疗后SLE-DAI显著下降(20.5+4.6)分下降至(11.9+1.2)分,P0.05];(3)血肌酐Scr均显著下降(330.5+207.2)umol/L下降至(260.4+59.1)umol/L,P0.05];(4)不良反应:一例出现过敏反应。结论免疫吸附能较好的清除狼疮性肾炎患者体内的多种自身抗体,使患者的SLE-DAI下降,肾功能好转。因此,它是治疗狼疮性肾炎的一种特异性强、疗效可靠、安全的技术。

Clinical Observation of Immunoadsorption for the Treatment of Lupus Nephritis

Objective To observe clinical effect of immunoadsorption for the treatment of lupus nephritis.Methods 15 patients,who were 12 females,3 males,and 17-42 years old,with severe LN including class Ⅳ（n=10）and class Ⅴ＋Ⅳ（n=5）were studied.Among them,there were 15 cases（100%）with elevating serum creatinine（SCr）average（330.5＋207.2） umol/L].The parameters of immunologic examination,erythrocyte sediment rate,systemic lupus erythematosus disease activity index（SLE-DAI）,renal function were evaluated.Adverse reactions were observed.Results 1）The titers of ANA and anti-dsDNA,erythrocyte sediment rate（ESR） were significantly declined after immunoadsorption ANA from（1∶1800）to（1∶200）,P0.01;anti-dsDNA（38.9 ＋10.3） IU/L to（20.1＋9.6） IU/L,P〈0.05;ESR from（75.0＋12.0） mm/h to（24.0＋8.0） mm/h,P〈0.05],while the levels of complement C3 were increased from（0.65＋0.22） g/L to（0.82＋0.31） g/L（P〈0.05）;2）SLE—DAI was decreased significantly from 20.5＋4.6 to 0.82＋0.31（P〈0.05）;3）Scr was decreased significantly from（330.5＋207.2） umol/L to（260.4＋59.1） umol/L（P〈0.05）;4）Adverse reaction： 1 cases had hypersensitivity.Conclusion IA could rapidly and effectively removed all kinds of autoantibodies in LN.It assay to decrease in patients with SLE-DAI,renal function improved.So it is a treatment of lupus nephritis as a specific,effective and reliable security technology.