血浆吸附改善重症狼疮性肾炎并肾损伤患者免疫功能和预后的前瞻性对照研究

发布时间：2019-02-13 07:59

【摘要】：目的探讨血浆吸附改善重症狼疮性肾炎合并急性肾损伤患者免疫功能和预后的效果。方法前瞻性连续选取收治的重症狼疮性肾炎合并急性肾损伤患者50例,根据信封法分为血浆吸附组(n=25)和对照组(n=25)。对照组在常规肾内科治疗的基础上采用强的松45~60 mg/d诱导治疗和大剂量(0.5~1.0 g/d)甲泼尼龙冲击治疗,血浆吸附组在对照组的基础上采用血浆吸附技术治疗。统计比较两组疗效、治疗前后24 h蛋白尿水平、血沉、血肌酐、免疫球蛋白A(Ig A)、免疫球蛋白G(Ig G)和免疫球蛋白M(Ig M)等免疫球蛋白、CD3~+、CD4~+和CD8~+T淋巴细胞亚群水平、28 d病死率及不良反应发生率等。结果与对照组比较,血浆吸附组缓解率提高,治疗后的24 h蛋白尿水平、血沉和血肌酐水平均降低,各免疫球蛋白水平,CD3~+计数均提高,CD4~+和CD8~+计数则降低(P0.05)。与治疗前比较,两组治疗后的24 h蛋白尿水平、血沉、血肌酐水平、各免疫球蛋白水平、CD3~+计数均降低,CD4~+和CD8~+计数组升高(P0.05)。血浆吸附组28 d死亡率为8.00%,低于对照组的32.00%(P0.05)。两组治疗期间均无明显不良反应发生。结论常规治疗基础上行血浆吸附治疗重症狼疮性肾炎合并急性肾损伤疗效良好且有利于改善患者的免疫功能和预后,是重症狼疮性肾炎合并急性肾损伤安全有效的治疗方法,值得临床推广应用。
[Abstract]:Objective to investigate the effect of plasma adsorption on immune function and prognosis in patients with severe lupus nephritis complicated with acute renal injury. Methods Fifty patients with severe lupus nephritis complicated with acute renal injury were prospectively selected and divided into two groups according to envelope method: plasma adsorptive group (nong25) and control group (nong25). The control group was treated with prednisone 45 ~ 60 mg/d induction therapy and high dose (0.5 ~ 1.0 g / d) methylprednisolone shock therapy on the basis of routine renal medical therapy. Plasma adsorption group was treated with plasma adsorption technique on the basis of the control group. The therapeutic effects of the two groups were compared statistically. The levels of proteinuria, erythrocyte sedimentation rate, serum creatinine, immunoglobulin A (Ig A), immunoglobulin G (Ig G) and immunoglobulin M (Ig M) were compared before and after treatment. The levels of T lymphocyte subsets of CD4~ and CD8~, the fatality rate of 28 days and the incidence of adverse reactions. Results compared with the control group, the remission rate of the plasma adsorption group was increased, the levels of proteinuria, erythrocyte sedimentation rate and serum creatinine were decreased, the immunoglobulin levels and CD3~ counts were increased, and the CD4~ and CD8~ counts were decreased (P0.05). Compared with before treatment, the levels of proteinuria, erythrocyte sedimentation rate, creatinine, immunoglobulin and CD3~ in the two groups were lower than those before treatment, and the CD4~ and CD8~ counts were higher in the two groups (P0.05). The 28 day mortality of plasma adsorption group was 8.00%, which was lower than that of control group (32.00%) (P0.05). There was no significant adverse reaction during treatment in both groups. Conclusion Plasma adsorption is a safe and effective method for the treatment of severe lupus nephritis complicated with acute renal injury on the basis of routine treatment, and it is beneficial to improve the immune function and prognosis of patients with severe lupus nephritis complicated with acute renal injury. It is worth popularizing and applying in clinic.
【作者单位】：梅州市人民医院血液净化中心;梅州市人民医院重症医学科;
【基金】：梅州市科技计划项目(编号:2014B91)
【分类号】：R593.242;R692

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