To Observe The Curative Effect Of Belimumab In The Treatment Of Systemic Lupus Erythematosus

Systemic lupus erythematosus(SLE)is a chronic autoimmune connective tissue disease whose etiology is not yet fully clear.Its pathogenesis is not very clear.At present,it has been found that multiple factors such as infection,immune dysfunction,genetics and environment play an important role in the pathogenesis.effect.Its typical feature is the production of a variety of pathogenic autoantibodies in the body,the formation of a large number of autoimmune complexes(IC)deposited in various tissues and organs,and then the skin,heart,lung,kidney,blood system,and central nervous system.Organ and system damage.The clinical manifestations and severity of SLE patients are different,and its complications are one of the important causes of death,such as lupus nephritis(LN),neuropsychiatric lupus(NPSLE),cardiovascular disease,thrombotic events,etc.At present,the cornerstone drugs for the treatment of systemic lupus erythematosus are hormones(GC)and immunosuppressants.Some patients have poor curative effect and recurrent illness.Long-term use of these drugs may cause some serious side effects,such as increased infection,osteoporosis,Liver and kidney damage,steroid diabetes,etc.so the treatment of SLE is still challenging.More and more scholars have discovered that B cells play an important role in the pathogenesis of SLE.For example,the initiation of systemic autoimmune response by SLE is related to the imbalance of B cell signal transduction,and the excessive proliferation and clearance of B cells in SLE cause the activation of autoantigens.Pathogenic autoantibodies are produced.Activated B cells can stimulate the production of a variety of chemokines and inflammatory factors.In addition,abnormal B cell signal transduction,tolerance defects and abnormal immune regulation mechanisms caused by environmental and genetic factors are in SLE.It also plays a key role in the occurrence and development of SLE,which ultimately leads to the onset of SLE and the continued activity of the disease.In recent years,the gradual in-depth study of B cells has found that the survival,maturation and differentiation of B lymphocytes involve the intervention of a variety of B cell-related cytokines.Among them,B lymphocyte stimulating factor(BLyS)has attracted much attention,also known as B cells.Activation factor(BAFF).BAFF is closely related to the disease progression of SLE.With the gradual clarification of the mechanism of BAFF in SLE,the development of drugs targeting BAFF has become a research hotspot,adding new treatments to SLE.Belimumab is the first targeted drug that selectively targets BAFF,that is,a specific biological inhibitor of BLyS,which is completely humanized recombinant IgG1-λ monoclonal antibody.So far,foreign clinical research results on the application of Belimumab.to SLE show that it can significantly improve the clinical symptoms of SLE patients,reduce disease activity,and reduce the dependence of patients on hormones,with few side effects,and the applicable population is serum autoantibodies.Positive active SLE patients.At the end of 2019,my country officially approved the listing of Belimumab.At present,only a few patients with SLE in China are treated with Belimumab.Objective:The purpose of this trial is to study the effectiveness of Belimumab in the treatment of systemic lupus erythematosus.Methods : 1.Selected patients who attended the Department of Rheumatology and Immunology in our hospital from October 2019 to December 2020,and met the inclusion and exclusion criteria,and were divided into two groups,the observation group was treated with belimumab+ prednisone + Hydroxychloroquine + mycophenolate mofetil treatment,while the control group was treated with prednisone + Hydroxychloroquine+ mycophenolate mofetil treatment,and the observation time was 24 weeks.2.Respectively to complement of the two groups the zero week of treatment,the fourth week of treatment,the eighth week of treatment,the sixteenth week of treatment,and the twenty-fourth week of blood sedimentation,liver and kidney function,Immunoglobulin,complement C3,complement C4,routine blood,c-reactive protein,lymphocyte subsets,a positive antinuclear antibody spectrum number,24 h urine protein quantitative,disease activity score and the dosage of prednisone;percutaneous renal biopsy was collected to collect renal pathological types.3.The above data were analyzed using SPSS 26.0 statistical software,and a P value<0.05 was considered as a significant statistical difference.Results: 1.A total of 48 SLE patients in this study met the criteria for inclusion and exclusion,of which 24 were in the observation group and the matched group.The gender,age and disease course data of the two groups showed P>0.05,and there was no statistically significant differences.2.There was no statistically significant difference in liver and kidney function,erythrocyte sedimentation rate,C-reactive protein and immunoglobulin in the 0th week of treatment and 24 th week of treatment between the two groups(P>0.05).During the treatment follow-up period,the red blood cells,platelets,and hemoglobin in the observation group continued to rise,and the total B cells and percentage values in the lymphocyte subsets decreased significantly compared with the previous period.There were differences between the 0th week of treatment and the 24 th week of treatment with statistically significant(P<0.05);NK cells,CD4+ cell counts and CD4+/CD8+ ratio showed a rising trend,while the number of lymphocytes and CD8+ cells decreased progressively,and there was no statistical significance(P>0.05)The serum levels of complement C3(P=0.002)and complement C4(P=0.018)increased significantly,and the SLEDAI score continued to decrease(P=0.025),with significant statistical differences between the 0th week of treatment and the 24 th week of treatment;24H The quantification of urine protein decreased from(2.46±1.03)before treatment to(0.51±0.246),the difference is significant between the 0th week of treatment and the 24 th week of treatment(P=0.001);the dose of prednisone varies with the treatment cycle The prolongation and gradual decrease,from(32.03±6.86)at baseline to(8.16 ±2.87),the difference is significant between the 0th week of treatment and the 24 th week of treatment(P=0.017).3.The number of positive autoantibodies in the antinuclear antibody spectrum between the two groups at the 24 th week of treatment was statistically different(P<0.05).4.A total of 16 patients in the observation group were diagnosed as LN by percutaneous renal biopsy,and more than70% of patients achieved LN remission at the end of follow-up.5.There was1 case of allergic reaction in the observation group during the treatment.Conclusion:1.Combined with belimumab can effectively promote platelet production and increase the concentration of red blood cells and hemoglobin;2.Combined with belimumab can reduce proteinuria,relieve lupus nephritis,and help to reduce the dosage of glucocorticoids;3.Combined with belimumab can reduce the activation of B cells and improve anti-ds DNA antibody turning negative rate.