摘要
目的:观察双重血浆置换(DFPP)联合免疫抑制剂治疗重症狼疮性肾炎(LN)治疗效果及对外周血尿白蛋白(Alb)、血尿素氮(BUN)、白细胞(WBC)水平的影响。方法:回顾性分析2019年1月至2020年12月在我院接受治疗的重症LN患者,根据治疗方案分为观察组(n=67)和常规组(n=75),常规组通过免疫抑制剂和激素进行治疗,观察组在此基础上进行DFPP,比较治疗6个月后两组患者临床疗效、肝肾功能指标、免疫指标以及不良反应发生情况。结果:治疗后,观察组总缓解率(93.33%)显著高于常规组(79.10%)(P<0.05);治疗6个月后,两组患者Alb水平、血清总胆红素(TBIL)水平较治疗前均显著升高(P<0.05),BUN、血肌酐(Scr)、尿蛋白水平较治疗前均显著降低,且治疗后组间对比差异有统计学意义(P<0.05);两组治疗前后尿蛋白水平差值比较无统计学意义(P>0.05),Alb、BUN、Scr、TBIL水平差值比较有统计学意义(P<0.05);治疗6个月后,两组患者抗DsDNA抗体阳性率、WBC水平、血管细胞黏附分子-1(VCAM-1)水平较治疗前均显著降低(P<0.05),补体C3水平较治疗前显著提高(P<0.05),且治疗后组间对比差异有统计学意义(P<0.05),两组治疗前后DsDNA抗体阳性率差值比较无统计学意义(P>0.05),WBC水平、尿VCAM-1水平、补体C3水平差值比较有统计学意义(P<0.05);治疗期间,观察组和常规组不良反应发生率分别为18.67%、14.93%,差异无统计学意义(P>0.05)。结论:免疫抑制剂联合DFPP治疗重症LN具有较佳效果,能有效改善患者肝肾功能,调节免疫水平,加快病情恢复,且药物安全性良好,推荐临床使用。
Objective:To observe the efficacy of double filtration plasmapheresis(DFPP)combined with immunosuppressant in the treatment of severe lupus nephritis(LN)and its influence on the levels of peripheral blood urinary Albumin(Alb),blood urea nitrogen(BUN)and white blood cell(WBC).Methods:Patients with severe lupus nephritis who were treated in the hospital between January 2019 and December 2020 were retrospectively analyzed,and they were divided into observation group(n=67)and routine group(n=75)according to the treatment regimens.The routine group was treated with immunosuppressant and hormone,and the observation group was administered double filtration plasmapheresis on this basis.The clinical efficacy,liver-kidney function indicators,immune indicators and occurrence of adverse reactions were compared between the two groups after 6 months of treatment.Results:After treatment,the total remission rate of observation group was significantly higher than that of routine group(93.33%vs 79.10%)(P<0.05).After 6 months of treatment,the levels of Alb and serum total bilirubin(TBIL)of the two groups of patients were significantly enhanced compared to before treatment(P<0.05)while the levels of BUN,serum creatinine(Scr)and urine protein were significantly decreased compared to before treatment(P<0.05),and the differences between the groups were statistically significant after treatment(P<0.05).There was no statistical significance in the difference of urine protein before and after treatment between the two groups(P>0.05),and there were statistical significance in the differences of Alb,BUN,Scr and TBIL(P<0.05).After 6 months of treatment,the positive rate of anti-DsDNA antibody and levels of WBC and vascular cell adhesion molecule-1(VCAM-1)in the two groups were significantly lower than those before treatment(P<0.05)while the level of complement C3 was significantly higher than that before treatment(P<0.05),and there were statistically significant differences between the two groups after treatment(P<0.05).There was no statistical significance in the difference of positive rate of DsDNA antibody before and after treatment between the two groups(P>0.05),but there were statistical significance in the differences of WBC level,urine VCAM-1 level and complement C3 level(P<0.05).During treatment,the incidence rate of adverse reactions was 18.67%in observation group and was 14.93%in routine group respectively(P>0.05).Conclusion:Immunosuppressant combined with DFPP has a better effect in the treatment of severe lupus nephritis.It can effectively improve the liver-kidney function,regulate the immune level and accelerate the recovery of disease,and it has safety of medication and is recommended for clinical application.
作者
万微波
卢蓉
熊蓉
汪超阳
范学朋
胡述立
WAN Weibo;LU Rong;XIONG Rong(Wuhan First Hospital,Hubei Wuhan 430000,China)
出处
《河北医学》
CAS
2022年第1期61-66,共6页
Hebei Medicine
基金
湖北省武汉市医学科研项目,(编号:WX1B33)。
关键词
双重血浆置换
免疫抑制剂
重症狼疮性肾炎
尿白蛋白
血尿素氮
Double filtration plasmapheresis
Immunosuppressant
Severe lupus nephritis
Urinary albumin
Blood urea nitrogen
