中华皮肤科杂志 ›› 2008, Vol. 41 ›› Issue (9): 568-570.

• 论著 • 上一篇    下一篇

联合大剂量丙种球蛋白治疗重症SLE 17例

周英 梁云生 张静 苏玉文 肖嵘 陆前进   

  1. 中南大学湘雅二医院 中南大学湘雅二医院 中南大学湘雅二医院 中南大学湘雅二医院 长沙中南大学湘雅二医院皮肤性病科 中南大学湘雅二医院
  • 收稿日期:2007-10-15 修回日期:2007-11-01 发布日期:2008-09-15
  • 通讯作者: 周英 E-mail:zhouying@medmail.com.cn

Combined high-dose intravenous immunoglobulin in the management of severe systemic lupus erythematosus

周英 Zhou Ying Liang Yun-sheng Liang Zhang Jing Zhang Su Yu-wen Su   

  • Received:2007-10-15 Revised:2007-11-01 Published:2008-09-15
  • Contact: 周英 Zhou Ying E-mail:zhouying@medmail.com.cn

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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。

关键词: 系统性红斑狼疮, 免疫球蛋白

Abstract: 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 methylprednisolone （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 IVIG was given repeatedly with an interval of 1 month for 2-5 sessions. Patients in MP group were treated with the same corticosteroids and immunosuppressants 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 immunosuppressants of routine dose and those accompanied by severe infections and intolerable to high dose of corticosteroids and immunosuppressants.

Key words: systemic lupus erythematosus, intravenous immunoglobulin