| Lupus nephritis(LN)is the secondary kidney involvement of systemic lupuserythematosus(SLE). It's clinic manifestation is mostly the same as nephriticsyndrome or chronic glomerulinephritis, which includes bulk proteinuria,haematuria, all kinds of cylindruria, azotemia, edema and hypertension, anduremia is the late stage, which is one of the most common reasons of the deathof SLE. Almost every patient can have kidney involvement during course ofdisease, which indicates badly prognosis, and a lot of patients also have kidneyinvolvement when SLE is relieved, so the death reason is late stage nephron.The pathogenesis of LN is complex, which is generaly accepted as thenephritis mediated by immune complex. Among the numerous pathogenicautoantibodies, anti-DNA antibody is powerful correlating to kidney damage.Follow is the capable mechanism: ①anti-DNA antibody first combinates withDNA, and forms cycle immune complex, which deposits in the glomeruli;②DNA preliminary binds in the glomeruli basement membrane, then absorbsanti-DNA antibody forming normal position immune complex.At present, the main therapy of LN is still immune suppression.Glucocorticoid is the foundamental drug, according to the principle of fulldosage, whole range and slow decrement, it can induce LN to remission, butmost LN patients can't receive complete remission when they are only treatedwith glucocorticoid, especially the type IV and type V LN, furthermore, longtime and massive application may lead to such adverse reactions as hypertention,hyperglycaemia, hyperlipemia, osteoporosis, peptic ulcer, infection and sterilenecrosis of femoral head etc. therefore, glucocorticoid combined withimmunosuppressive agent is extensive applicated in clinic, not only elevatestherapeutic efficacy, but also decreases the dosage of glucocorticoid and it'sadverse reaction.Intravenous impulsing cyclophosphamide(CTX) is mostly applicatedamong immunosuppressive agents, and it's therapeutic efficacy is sure. CTX is akind of cytotoxic drug, may lead to myelosuppression, hepatotoxicity, infection,nephrotoxicity, peptic ulcer, Hemorrhagic cystitis and gonad depression etc afterlong time and massive application. Some patients can't tolerant CTX's adversereaction and stop using, as a result, LN can't get complete remission. Otherimmunosuppressive agents include azathioprine, Cyclosporin A ect, but theirtherapeutic efficacies are not sure as CTX, further, they all have some of thesame adverse reactions as CTX more or less.Neotype immunosuppressive agents which have been applicated in clinicinclude Mycophenolate Mofetil(MMF), Leflunomide(LEF) and FK506 etc.MMF is most generally studied, through massive clinic observation, it wascertificated the same therapeutic efficaciy as CTX, the less adverse reaction. Butit's price is expensive, nowadays, it is not suitable for widespread application.LEF is a kind of inhibitors that inhibites the synthesis of pyrimidine, throughdepressing the activity of dihydrolactic acid dehydrogenase, depresses theproduction of IL-2, TNF-α,blocks the proliferation of actived lymphocyte,decreases the production of antibody. It is mainly used in the treatment ofrheumatoid arthritis and ankylosing spondylitis at present, getting goodtherapeutic efficacy. Recently, it is applicated in the treatment of LN, alsogetting good therapeutic efficacy. But these clinic observations were almostsmall sample, and didn't compare with immunosuppressive agents whosetherapeutic efficacy were sure. Other reports show that LEF can lead to acuteinterstitial pneumonia, even result in death in some severe cases. So in thisarticle, we compare with methylprednisolone only and methylprednisolonecombined with CTX respectively, in order to certificate it's short termtherapeutic efficacy in the treatment of LN, and observes whether LEF caninduce some severe adverse reactions, such as acute interstitial pneumonia.This article is a retrospective clinical observation of medical therapeuticefficacy. 110 patients are divided into three groups, given methylprednisoloneonly(MET group), methylprednisolone combined with CTX(CTX group) andmethylprednisolone combined with LEF(LEF group) respectively, and observestherapeutic efficacy both in one month later and two month later.The results display:1.One month after treatment, the accumulated remmision rate of CTXgroup(50%) is higher than the other two groups, having significant differencewith MET group(P<0.05), but nor with LEF group. Tow month after treatment,the accumulated remmision rate of LEF group is the highest(67%), havingsignificant difference with MET group(P<0.05), but nor with CTX group.2.One month after treatment, the decreasing amplitude of 24 hour's urineprotein is highest in CTX group, and has significant difference with METgroup(P<0.05), but nor with LEF group. Two month after treatment, thedecreasing amplitude of 24 hour's urine protein is highest in LEF group, butdoesn't have significant difference with CTX group.3. Myelosuppression, damage of liver function, severe infection andresponses of gastrointestinal tract are mainly seen in CTX group. The majorityadverse reaction in LEF group is acute interstitial pneumonia.Conclusions:1.Both methylprednisolone only and methylprednisolone combined withimmunosuppressive agents, can get remmision more or less in the trratment ofLN.2.The therapeutic efficacy of methylprednisolone combined with immunos-uppressive agents is significantly better than that of methylprednisolone only.3. LEF can attain the same therapeutic efficacy as CTX in the treatment ofLN, decreasing urine protein in big amplitude, elevating the level of suremalbumin, controlling the disease's activity.4.The incidence rate of adverse reactions, such as myelosuppression,damage of liver function, severe infection and responses of gastrointestinal tractin CTX group is higher than that in LEF group, and more severe.5. LEF can cause acute interstitial pneumonia in a short time(within 2months), and result in badly prognosis. |
PDF Full Text Request