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目的:采用多靶点方法激素+他克莫司FK506+环磷酰胺联合治疗25例Ⅴ+Ⅳ型难治性狼疮性肾炎,观察多靶点方法对Ⅴ+Ⅳ型狼疮性肾炎的疗效及安全性。方法:选取25例肾活检明确为Ⅴ+Ⅳ型LN患者,所有病例均采用中小剂量泼尼松联合FK506+CTX治疗,随访观察12个月,观察治疗前与治疗6、12个月24小时尿蛋白定量、尿沉渣、血常规、肝肾功能、血白蛋白、补体C3等,同时行SLE-DAI评分。结果:经过6个月激素+FK506+CTX联合治疗后,完全缓解率为38.5%;治疗12个月完全缓解率为51.2%,总体有效率达到91.8%,20例患者(83.3%)SLE-DAI≤5。白蛋白、尿蛋白及SLE-DAI治疗6个月与治疗前、治疗12个月与治疗6个月比较差异显著(P<0.01),疗效比较理想,不良反应少,所有不良反应经对症治疗均得到恢复。结论:采用激素+FK506+CTX多靶点治疗Ⅴ+Ⅳ型LN,不仅能抑制T淋巴细胞和B淋巴细胞增殖,还能减轻膜性病变,FK506还能直接通过抑制足细胞的过度活化,改善足细胞功能,从而减少蛋白尿,所以大大提高了对V+IV型狼疮性肾炎的治疗效果。本研究未发生严重的药物不良反应,而且联合用药可以减少细胞毒药物的剂量,从而大大减少药物的不良反应,使治疗的安全性得到提高,延长了有效治疗的周期,值得临床推广应用。
Objective: To investigate the efficacy and safety of multi-target therapy for Ⅴ + Ⅳ type lupus nephritis in combination with FK506 + cyclophosphamide with multi-target method in 25 patients with type Ⅴ + Ⅳ refractory lupus nephritis . Methods: Twenty-five cases of LN with definite renal biopsy were selected as type Ⅴ + Ⅳ. All cases were treated with low and middle dose prednisone combined with FK506 + CTX. The patients were followed up for 12 months. The 24 hours urine before treatment and 6,12 months Protein quantification, urine sediment, blood, liver and kidney function, serum albumin, complement C3, while SLE-DAI score. Results: The complete remission rate was 38.5% after 6 months of combination of hormones + FK506 + CTX. The complete remission rate was 51.2% at 12 months, the overall effective rate was 91.8%, and 20 cases (83.3%) with SLE-DAI ≤5. Albumin, urine protein and SLE-DAI treatment for 6 months and before treatment, 12 months of treatment and 6 months of treatment was significantly different (P <0.01), the effect is ideal, fewer adverse reactions, all adverse reactions were symptomatic treatment Be restored. Conclusion: Hormone + FK506 + CTX multi-target treatment of Ⅴ + Ⅳ LN can not only inhibit the proliferation of T lymphocytes and B lymphocytes, but also reduce the membranous lesions. FK506 also can directly inhibit the excessive activation of podocytes and improve Podocyte function, thereby reducing proteinuria, so greatly improved the treatment of type V + IV lupus nephritis. The study did not occur serious adverse drug reactions, and the combination of drugs can reduce the dose of cytotoxic drugs, thereby greatly reducing the adverse drug reactions, the treatment of increased safety and extend the effective treatment cycle, worthy of clinical application.