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目的观察激素、免疫抑制剂联合用药治疗系统性红斑狼疮(SLE)的疗效,并探讨其作用机制。方法回顾性分析51例活动期SLE,根据不同的用药方法分A组用环磷酰胺+长春新碱+泼尼松(CTX+VCR+Pred)和B组用环磷酰胺+泼尼松(CTX+Pred),分别观察治疗前,治疗后3个月、12个月的各项指标以及不良反应的发生情况。结果治疗前两组系统性红斑狼疮疾病活动指数(SLEDAI)评分等各项指标相比差异无统计学意义(P>0.05),具有可比性。治疗后3个月,两组各项观察指标与治疗前对比均明显改善。A组SLEDAI,血沉(ESR),补体C3、C4及24 h尿蛋白定量的改善较B组明显,两组间比较差异有统计学意义(P<0.05),而尿素氮(BUN)、血肌酐(Scr)及白蛋白(ALB)指标改善差异无统计学意义(P>0.05)。治疗后12个月与治疗后3个月比较,两组各项观察指标均进一步改善,A组SLEDAI、ESR、24 h尿蛋白定量、BUN及Scr的改善较B组明显,组间比较差异有统计学意义(P<0.05)。补体C3、C4,ALB两组间比较差异无统计学意义(P>0.05)。不良反应包括白细胞减少、带状疱疹、感染、肝功能损害、月经不调、胃肠道反应,两组发生率差异无统计学意义。结论 CTX+VCR+Pred联合用药治疗SLE,疗效优于标准方案CTX+Pred。其可能的机制是细胞周期特异性药物(VCR)与细胞周期非异性药物(CTX)联用能更有效地抑制B淋巴细胞的活化,减少抗体产生,降低炎症介质水平,诱导疾病缓解。
Objective To observe the curative effect of hormone and immunosuppressive agents combined with drugs on systemic lupus erythematosus (SLE) and to explore its mechanism. Methods Fifty-one patients with active SLE were retrospectively analyzed. Patients in group A received cyclophosphamide plus vincristine plus prednisone (CTX + VCR + Pred) and patients in group B received cyclophosphamide plus prednisone (CTX + Pred), respectively, before treatment, 3 months after treatment, 12 months of the indicators and the occurrence of adverse reactions. Results Before treatment, there was no significant difference in SLEDAI score between the two groups (P> 0.05), which was comparable. Three months after treatment, the two groups of various indicators were significantly improved compared with before treatment. The quantification of SLEDAI, ESR, C3, C4 and 24 h urinary protein in group A was significantly better than that in group B, and there was significant difference between the two groups (P <0.05). The levels of BUN and serum creatinine (Scr) and albumin (ALB) improved no significant difference (P> 0.05). After 12 months of treatment and 3 months after treatment, the two groups were further improved in all indicators, A group of SLEDAI, ESR, 24 h urinary protein, BUN and Scr improved compared with the B group, the difference was Statistical significance (P <0.05). Complement C3, C4, ALB between the two groups showed no significant difference (P> 0.05). Adverse reactions, including leukopenia, shingles, infections, liver damage, irregular menstruation, gastrointestinal reactions, the incidence was no significant difference between the two groups. Conclusions The combination of CTX + VCR + Pred and SLE is better than the standard CTX + Pred in the treatment of SLE. The possible mechanism is that cell cycle-specific drugs (VCRs) combined with CTX can effectively inhibit the activation of B lymphocytes, reduce antibody production, reduce the level of inflammatory mediators and induce disease remission.