Clinical And Experimental Study Of Vincristine And Cyclophosphamide In Patients With Systemic Lupus Erythematosus

【Backgrounds】Systemic lupus erythematosus(SLE)is a complex autoimmune disease which involves inmany organs through lots of aspects.It occurs in young women. Currently respected prednisone(pred) and cyclophosphamide(CTX) scheme (pred 1-2mg/Kg/day,CTX 800-1000mg/time, 3 for acourse of treatment) has the shortage of high dose of CTX and poor tolerance which may beabout 35% of the patients. Learning from the successful experiences of treating lymphoma, ourdepartment uses the improved COP scheme (VCR combined with low dose CTX treatmentperiod) in SLE therapy with good effect. The improved COP scheme: Pred 0.5-1mg/Kg / dayoral,first day of the VCR 1mg / sub static point,second day of the CTX 400mg-600 / times ofstatic points, 3 weeks for a course. After stable condition: the first day of the VCR 1mg / substatic point, the second day of CTX 200mg-400 / time point. Our department has been used thisscheme for more than 10 years, and the effect is definite. VCR combined low dose of CTX hasthe equivalent effect with CTX, but adverse reactions are lower in comparison with CTX, so it isrelatively safe. And BAFF / BAFFR system may be a way of VCR combined CTX treatment.The cause of SLE is unknown and immune system disorders are throughout the course ofdisease.It is the main pathogenesis which T lymphocyte abnormalities and B lymphocytesoveractivity eventually leading to excessive activation of the abnormal immune system response.B-cell activating factor (BAFF) is a recent discovery member of tumor necrosis factor (TNF)family and its main role is the regulation of B lymphocyte function which in B lymphocyteactivation, proliferation and survival, at the same time, it regulate T lymphocytes in a certaindegree.BAFF biological activity mainly through the implementation of its three receptorinteraction.The newly discovered third receptor BAFF-R is the specificity of BAFF receptorwhich plays an important regulation role in B cell development and functions and involves inregulating B cell homeostasis disorders.Through the study of clinical trials in this subject, weevaluate clinical conditions in SLE patients and research the role and significance of BAFF andBAFF-R in the pathogenesis of SLE. This can provide the new ideas, methods, and evaluationindicators for the occurrence, development and treatment evaluation of SLE.【Objective】1.To evaluate clinical efficacy and safety of VCR and CTX combination therapy;2.To approach the change ofPBMC BAFF and BAFF-R Mrna.【Methods】1.To carry out a random contrastive single study about 24 weeks. 2.Part of clinical: after 38 actively patients with SLE was chose successfully,they were randomlydivided into CTX pause group and VCR+CTX combination group.To study the change of ESR,B lymphocyte, SLEDAI and PGA. There are 24 weeks from set up to finish.3.Part of experiment: after 19 actively patients with SLE was chose successfully, they wererandomly divided into CTX pause group and VCR+CTX combination group. Meanwhile. Todetect the change of PBMC BAFF and BAFF-Rm RNA.There are 24 weeks from set up tofinish.【Results】1.Evaluation of efficacy: the combination of VCR and CTX could significantly decrease thenumerical value of ESR, B lymphocyte, SLEDAI and PGA.2.Evaluation of safety: there is no difference of adverse effect between VCR+CTX combinationgroup and CTX pause group (P＜0.05).3.Change of Serum BAFF levels in the two groups was not significant.Compared the two groups,VCR combined low dose CTX group expression levels of PBMC BAFF and BAFF-R mRNAwere not statistically significant.The two groups compared expression levels of PBMC BAFFand BAFF-R mRNA before, after treatment was statistically significant (P＜0.05).【conclusion】The Combined VCR and CTX group can significantly improve the condition.. The adverseeffect of VCR+CTX combination group was similar to CTX pause group.. The combination ofVCR and CTX could effectively decrease the amount of PBMC BAFF and BAFF-R mRNA .