摘要
目的探究环磷酰胺联合激素疗法治疗狼疮肾炎(LN)合并慢性肾功能不全患者的临床疗效及安全性。方法选取固始县人民医院2021年10月至2023年10月符合纳入标准的80例LN合并慢性肾功能不全(CRI)患者,按照信封法均分为观察组(环磷酰胺联合激素治疗,n=40)和对照组(激素治疗,n=40),两组治疗后对比疗效、系统性红斑狼疮疾病活动指数(SLEDAI)评分、生化指标[免疫球蛋白G(IgG)、C反应蛋白(CRP)、红细胞沉降率(ESR)、尿素氮(BUN)、血肌酐(SCr)、血尿酸(UA)、补体C3、24 h尿蛋白定量(24 hUPQ)]和不良反应。结果观察组治疗有效率高于对照组,差异有统计学意义(P<0.05)。治疗后,两组SLEDAI评分均较治疗前降低,且观察组低于对照组,差异有统计学意义(P<0.05)。治疗后,两组24 hUPQ、UA、SCr、BUN、ESR、CRP、IgG水平均较治疗前降低,且观察组低于对照组,两组补体C3水平均较治疗前升高,且观察组高于对照组,差异有统计学意义(P<0.05)。两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论环磷酰胺联合醋酸泼尼松片治疗LN合并CRI,临床效果显著,可降低SLEDAI评分,改善肾功能,降低炎症水平,改善免疫功能,且短期安全性尚可;本研究提示,在密切监测下,基于肾功能和体表面积进行剂量调整的环磷酰胺个体化冲击方案,可为临床治疗提供参考。
Objective To investigate the clinical efficacy and safety of cyclophosphamide combined with glucocorticoid therapy in patients with lupus nephritis(LN)and chronic renal insufficiency.Methods A total of 80 patients with LN complicated by chronic renal insufficiency who met the inclusion criteria and were treated in Gushi County People’s Hospital from October 2021 to October 2023 were enrolled.According to the envelope method,they were randomly divided into an observation group(cyclophosphamide combined with glucocorticoid therapy,n=40)and a control group(glucocorticoid therapy alone,n=40).After treatment,the two groups were compared in terms of therapeutic efficacy,Systemic Lupus Erythematosus Disease Activity Index(SLEDAI)score,biochemical indices[immunoglobulin G(IgG),C-reactive protein(CRP),erythrocyte sedimentation rate(ESR),blood urea nitrogen(BUN),serum creatinine(SCr),uric acid(UA),complement C3,and 24-hour urinary protein quantity(24 hUPQ)]and adverse reactions.Results The overall response rate in the observation group was significantly higher than that in the control group(P<0.05).After treatment,SLEDAI scores in both groups were significantly lower than those before treatment,and the score in the observation group was significantly lower than that in the control group(P<0.05).After treatment,24 hUPQ,UA,SCr,BUN,ESR,CRP,and IgG levels in both groups were significantly reduced compared with baseline,with lower levels in the observation group than in the control group;complement C3 levels in both groups were significantly increased compared with baseline,with a higher level in the observation group than in the control group(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion Cyclophosphamide combined with prednisone acetate tablets for the treatment of LN complicated by CRI provides a significant clinical benefit,reduces SLEDAI scores,improves renal function,decreases inflammatory activity,and enhances immune function.Its short-term safety is acceptable and this study suggests that under close monitoring,cyclophosphamide individualized shock regimen with dose adjustment based on renal function and body surface area is recommended,thus it may serve as a useful reference for clinical practice.
作者
张显菊
张阳
ZHANG Xianju;ZHANG Yang(Department of Nephrology,Gushi County People’s Hospital,Xinyang,Henan 465200,China)
出处
《临床研究》
2025年第12期99-102,共4页
Clinical Research
关键词
环磷酰胺-激素疗法
狼疮肾炎
慢性肾功能不全
临床疗效
安全性
cyclophosphamide–glucocorticoid therapy
lupus nephritis
chronic renal insufficiency
clinical efficacy
safety
