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目的:观察激素、免疫抑制剂联合用药治疗狼疮肾炎(LN)的疗效,并探讨其作用机制。方法:回顾性分析65例活动期LN,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、6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显著性,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、补体及24 h尿蛋白定量的改善较B组明显,两组间差异有统计学意义(P<0.05)。尿素氮(BUN)、血清肌酐(Scr)及血清白蛋白(ALB)指标改善两组接近,组间差异无统计学意义(P>0.05)。治疗后6个月与治疗后3个月对比,两组各项观察指标均进一步改善,A组SLEDAI、24 h尿蛋白定量、BUN及Scr的改善较B组明显,组间差异有统计学意义(P<0.05),C3、C4、ALB两组间差异无统计学意义(P>0.05)。最常见不良反应是恶心、呕吐,其次是脱发、白细胞减少、月经不调等,两组发生率接近。结论:CTX+VCR+Pred联合用药治疗LN,疗效优于标准方案CTX+Pred联合用药,其可能的机制是细胞周期特异性药物(VCR)与细胞周期非特异性药物(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,以诱导缓解疾病。
Objective: To observe the curative effect of hormone and immunosuppressant in the treatment of lupus nephritis (LN) and to explore its mechanism. Methods: A retrospective analysis of 65 cases of active LN, according to different methods of treatment were divided into A group with cyclophosphamide + vincristine + prednisone (CTX + VCR + Pred) and B group with cyclophosphamide + prednisone CTX + Pred), respectively, before treatment, 3 months after treatment, 6 months of the indicators and the occurrence of adverse reactions. Results: Before the treatment, there was no significant difference between the two groups in the SLEDAI score, which was comparable. Three months after treatment, the two groups of various indicators were significantly improved compared with before treatment. The quantification of SLEDAI, complement and 24 h urinary protein in group A was better than that in group B, and the difference was statistically significant (P <0.05). The levels of BUN, Scr and ALB were improved in both groups. There was no significant difference between the two groups (P> 0.05). After 6 months of treatment and 3 months after treatment, the two groups of indicators were further improved, A group of SLEDAI, 24 h urinary protein, BUN and Scr improved compared with the B group, the difference between the two groups was statistically significant (P <0.05). There was no significant difference between C3, C4 and ALB (P> 0.05). The most common adverse reactions are nausea, vomiting, followed by hair loss, leukopenia, irregular menstruation, the incidence of the two groups close. Conclusions: The combination of CTX + VCR + Pred therapy with LN is superior to the combination of CTX + Pred with standard regimen. The possible mechanism is that combination of cell cycle specific drug (VCR) and cell cycle nonspecific drug (CTX) can be more effective Inhibit the activation of B lymphocytes, reduce antibody production, reduce the level of inflammatory mediators to induce disease relief.