摘要
目的探讨静脉滴注大剂量丙种球蛋白（IVIG）治疗重症SLE的临床疗效。方法对SLE患者采取分组对照研究。治疗组17例，用大剂量IVIG静脉滴注联合甲泼尼龙冲击治疗；对照组19例，单用甲泼尼龙治疗。比较两组临床疗效、血清学指标和狼疮活动度（SLAM）。结果两组症状均明显好转，疾病活动度均明显下降。近期疗效上IVIG组对减少SLAM、降低ANA和抗dsDNA阳性率、升血小板方面明显优于甲泼尼龙组（P〈0．05），远期疗效两组差异无统计学意义。IVIG组继发感染的发生率（11．8％）显著低于甲泼尼龙组（36．8％）。结论大剂量IVIG静脉滴注为辅助治疗重症SLE的有效手段之一，适用于常规剂量糖皮质激素和免疫抑制剂治疗疗效不佳患者，以及伴严重感染不宜高剂量糖皮质激素和免疫抑制剂治疗的患者。
Objective To investigate the efficacy of combined high-dose intravenous immunoglobulin （IVIG） pulse therapy in patients with severe systemic lupus erythematosus （SLE）. Methods Thirty-six patients were enrolled into this study, and randomly classified into IVIG group （n = 17） and methylpred- nisolone （MP） group （n = 19）. The treatment of patients in IVIG group began with a 3-day intravenous MP followed by intravenous IVIG 400 mg per kilogram of body weight per day for 3-5 days, then was switched to oral prednisone and cyclophosphamide at routine dose. Intravenous WIG was given repeatedly with an interval of 1 month for 2-5 sessions. Patients in MP group were treated with the same corticosteroids and as used in IVIG group but without IVIG. Patients were followed up for 3-12 months The clinical efficacy, related serum parameters, and systemic lupus activity measurement （SLAM） were evaluated and compared between the two groups. Results Most patients in both groups showed a remission of symptoms and reduction in disease activity after treatment. The decrease in SLAM, positivity rates of antinuclear antibodies and anti-double-stranded DNA （anti-dsDNA） antibodies as well as the increase in platelets were faster in IVIG group than those in MP group （all P 〈 0.05）, but the long-term efficacy of the two groups was similar （P 〉 0.05 ）. Infections occurred in 11.8% of patients in IVIG group and 36.8% of patients in MP group. Conclusions High-dose intravenous immunoglobulin may serve as an effective aid in the treatment of severe SLE, and is particularly beneficial to patients resistant to corticosteroids and immunosup- pressants of routine dose and those accompanied by severe infections and intolerable to high dose of corticosteroids and immunosuppressants.
出处
《中华皮肤科杂志》
CAS
CSCD
北大核心
2008年第9期568-570,共3页
Chinese Journal of Dermatology
关键词
红斑狼疮
系统性
免疫球蛋白类
治疗
Lupus erythematosus, systemic
Immunoglobulins
Therapy
