The Clinical Observation Of Thymosin In The Adjunct Treatment Of Refractory Lupus Nephritis

Purpose: Analyze the clinical features of children with refractory lupus nephritis;observe the curative effect and safety of thymosin ’auxiliary treatment of refractory lupus nephritis.Methods:In line with the Ameirican Rheumatism Association in 1997 revision of the systemic lupus erythmatosus diagnostic criteria[diagnostic criteria for LN:on this basis,have a persistent proteinuria>0.5g/d,3+or higer or more urine protein,and/or cell type tubeurine(for red blood cells,hemoglobin,particles or mixed tube type)].Selected 4 children with refractory lupus nephritis with thymosin ’auxiliary treatment in pediatric department of Renji Hospital affiliated to Shanghai Jiaotong university school of medicine in October 2011 to May 2015;analyzed and compared 4 cases′clinical manifestation,disease activity,laboratory examination,treatment and outcome of disease before and after thymosin.Results:1)The first patient′clinical features were eyelid edema,ANA1:640,ds-DNA10.7 IU/ml,low C3 and C4,ALB25.2 g/L,3.15 g/24 hours urinary protein,renal biopsy pathology type IV,accepted and cyclophosphamide treatment,the effect is not good,turned to methylprednisolone and tacrolimus(FK506)combined with thymosin;After treatment,eyelid edema disappeared,SLEDAI reduced to four points,urine protein became negative,immune function were improved,the disesase was complete response.2)The second patient′clinical features were lower limb edema,high blood pressure,low C3 and C4,ALB29.3 g/L,4.09 g/24 hours urinary protein,renal biopsy pathology type Ⅲ,accepted methylprednisolone and mycophenolate mofetil,but there were still a lot of proteinuria and edema,turned to triamcinolone tablets,tacrolimus(FK506)and hydroxychloroquine added with thymosin;After treatment,lower limb edema disappeared,SLEDAI reduced to 2 points,urine protein reduced to 630 mg / 24 h,immune function were improved,the disesase was part remission.3)The third patient′clinical features were edema,high blood pressure,ds-DNA11.21 IU/ml,2.76 g/24 hours urinary protein,renal biopsy pathology type IV,accepted methyl prednisolone,Leflunomide and thalidomide.The effect was poor.turned to methylprednisolone,Leflunomide and tacrolimus(FK506)combined with thymosin;anasarca disappeared,SLEDAI reduced to 2 minutes,urine protein became negative,immune function were improved,the disesase was complete response.4)The forth patient′clinical features were facial erythema,high blood pressure,ds-DNA11.21 IU/ml,1 g /24 hours urinary protein,renal biopsy pathological type Ⅲ + IV,accepted methylprednisolone,mycophenolate mofetil,but we did not see improvement,so the children turned tojoyo methylprednisolone and tacrolimus(FK506)combined with thymosin;After treatment,erythema disappeared,SLEDAI reduced to 2 minutes,urine protein became negative,immune function were improved,the disesase was complete response.Conclusion: 1.Thymosin ’auxiliary treatment of refractory lupus nephritis can improve patients ’clinical symptoms,increase the immune function,improve laboratory indicators,help glucocorticoids ’decrement.2.Thymosin ’ auxiliary therapy for refractory lupus nephritis is safe.3.Because the sample size is less,this study has yet to be further studied.