中等剂量丙种球蛋白治疗狼疮性肾炎并感染.docxVIP

中等剂量丙种球蛋白治疗狼疮性肾炎并感染 牛丹郝娅宁 耿瀛洲 袁美群 (西安交通大学医学院第一附属医院肾病医院肾内科710061) 【摘要】目的：观察静脉注射中等剂量丙种球蛋白(IVIG)治疗狼疮性肾 炎并细菌感染的临床效果及副反应。方法：27例病人为2010年?2013年我院住 院病人，诊断为狼疮性肾炎并细菌感染。肾功好转程度IVIG组16例给予：① IVIG200mg, / (kg?d),连续用3?5天;②小剂量激素治疗,强的松0.4mg/(kg?d), 严重者甲基强的松龙冲击治疗。③抗牛素治疗，根据药敏选择抗生素，或合成青 霉素或三代头泡，如皮试阳性选用卩奎诺酮类抗生素。对照组□例予：仅应用上 述小剂量激素治疗加抗牛素治疗。3-4周根据SLE活动积分及相关临床征象比较 两组临床治疗效果，并每周监测肝肾功、血常规等副反应。结果：治疗组SLE活 动积分、尿蛋白下降程度及肾功好转程度显著高于对照组，体温下降至正常、及 体征消失恢复正常时间显著低于对照组。治疗组监测副反应无明显肝功血液系统 损害，1例因皮疹，考虑过敏反应退出，停药后症状缓解。结论:中等剂量丙种球 蛋白冲击治疗SLE合并细菌感染能缩短感染时间，提高疗效缩短病情缓解时间, 可以获得较明显的临床效果，副反应轻微。 【关键词】丙种球蛋白 狼疮性肾炎 感染 【中图分类号】R969 【文献标识码】 A 【文章编号】2095-1752 (2014) 18-0272-02 Medium dose intravenous immunoglobulin pulse therapy in patients with systemic lupus erythematosus complicating infection. Dan Niu ‘Yaning Hao, Yingzhou Geng, Meiqun Yuan. Department of Nephrology,First Affiliated Hospital, College of Medicine, Xirsquo;an Jiaotong University,710061,China. [Abstract] Objective To evaluate the efficacy and indications of medium dose i nt rave nous immuno globuli n(IVIG)i n patie nts with lupus n ephritis (LN)complicating infection.Methods Twenty-seven patients with lupus nephritis (LN)complicating infection were divided into two groups: IVIG[IVIG at a dosage of 200 mg/(kg?d) for 3 to 5 consecutive days] with low dose of prednisone (0.4 mg/kg?d) P) in 16 patients as group 1, and low dose of prednisone alone in 11 patients as group 2.The therapeutic efficacy of these two groups were compared by calculating SLE activity scoring, urine protein, eGFR,the time of temperature drop and signs disappearanee, before and after treatments.Results SLE activity scoring and urine protein decreased more after the treatment in group 1 than in group 2. Renal fun ction in creased more in group 1 tha n in group 2. The time of temperature drop and signs disappearanee was shorter in group 1 than in group 2.Within 3 to 4 weeks after initiation of IVIG therapy patients showed normal hepatic function and blood routine test.Only one patient showed skin