上海仁济讲义资料关于SLE讲义课件.pptVIP

* Group A (n=30)*: prednisone 0.2mg/kg/d+ MTX 7.5-15mg/wk + chloroquine 0.25/d Group B (n=30)*: Prednisone 0.5-0.6mg/kg/d+ MTX 7.5-15mg/wk + chloroquine 0.25/d * One-year course Stage I: retrospective study Therapeutic efficacy of Group A and B Group A Group B Before therapy After therapy P0.05 Out Score A comparison of infection rate in 2 groups (7/30) (22/30) Infection rate Skin (25%) Respiratory tract (75%) The site of infection in the therapy of 2 groups (P0.01) Stage II: prospective study GroupA*: P.M.C group N=42 Prednisone 10mg/d (0.2mg/kg/d) + MTX 10mg/w + Chloroquine 0.25g/d GroupB* : controlled group N=20 Prednisone 0.5mg/kg/d * six month course A comparison of efficacy (SLEDAI score) between two groups *P0.05 Control group Comparison of weight gaining between two groups Control group *P0.05 Comparison of infection rate between two groups Control group *P0.05 The site of infection in the 2 groups Skin 30% Respiratory tract 62% Urinary tract 8% Comparisons of TG ,Cho,Glucose, Bone Density changes before and after therapy between two groups TG* Cho Glucose* Bone density* *P0.05 *P0.05 关于抗疟药治疗狼疮的新观点 羟氯喹的重要性越来越受关注，是一个很重要的狼疮病情改变药，它具有抗凝、降脂、减少激素用量和副反应的作用，发生视网膜病变的几率低。 一项研究表明，133名服用羟氯喹的孕妇，其成功妊娠的比率为88%（对照组为84%），对出生后的婴儿随访108个月，未发现视、听觉及生长发育的异常。但在FDA妊娠用药分类仍属C类 。 Nathalie Costedoat-Chalumeau. Safety of hydroxychloroquine in pregnant patients with connective tissue diseases . Arthritis Rheumatism 2003,48(11)3207-12 关于MTX在狼疮治疗中的应用 MTX治疗狼疮再次引起重视，MTX除了免疫抑制作用外，还具有多重抗炎作用，可增加炎症部位的腺苷水平、抑制白三烯形成及抑制Cox-2 。它可减低SLEDAI积分，减少激素用量。 临床试验证实MTX对狼疮的关节炎、皮疹、浆膜炎、白细胞破粹性血管炎有较好疗效。 目前尚无引起狼疮病人肺部毒性的报道。 ——Lupus(4th Ed). 2004. Robert G. Lahita 靶向治疗 对狼疮的免疫学发病机制,尤其是免疫调节通路的深入研究,促使靶向治疗成为可能。 SLE治疗的靶点 S Vasso and GRV Hughes. Lupus (2005) 14,181-188 ＊ anti-CD40L antibodies ＊ CTLA-4Ig Biological agents ＊ B7-1 mAbs ＊ T/B cell in