Clinical And Experimental Study Of Vincristine Combined Cyclophosphamide Treating Systemic Lupus Erythematosus

[Backgrounds]Systemic lupus erythematosus (SLE) is a complex autoimmune disease which involves many organs and systems. The cause of this disease remains unclear. There are nonsteroidal antiinflammatory drugs, glucocorticoids, antimalarial agents, and immunosuppressive drugs, including cyclophosphamide, methotrexate and mycophenolate mofetil, azathioprine, which used to treat SLE. The choice of the drug is determined largely by the severity of the disease and the function of the involved organ. Currently it hadn’t reliablely treatment program. New programs include biologic agent, plasmapheresis, stem cell transplantation which prostecdtive efficacy need to confirm and cost too much. So it is important to search the new treatment program.1960s, it is success that combination chemotherapy treat lymphoma. Lymphoma shows lymphocyte is monoclonal while SLE shows lymphocyte is poly clone. So we used VCR combined CTX treating SLE. VCR widely used to cure the SLE patient whose PLT was low. CTX is effective to treat lupus nephritis. But it isn’t valid to15%SLE patient and about30%-50%SLE patient can occur to final stage of nephritis. The side effect of CTX is infection, arrest of bone marrow and gonadoinhibitory. The cause of SLE is unknown, immune system disorders throughout the course of disease, T lymphocyte abnormalities, B lymphocytes eventually lead to excessive activation of the abnormal immune system response is the main pathogenesis. B lymphocyte stimulator is a recent discovery of tumor necrosis factor (TNF) family, a new member, the main role in the regulation of B lymphocyte function in B lymphocyte activation, proliferation and survival, and played an important role, but in a certain Degree of participation in the regulation of T lymphocytes. BAFF biological activity mainly through the implementation of its three receptor interaction, the newly discovered third receptor BAFF-R, is the specificity of BAFF receptor, BAFF binding and BAFF-R in B cell development Functions play an important regulatory role, and involved in regulating B cell homeostasis disorders. SLE patients in this subject through the study of clinical trials to evaluate clinical conditions SLE patients, of BAFF and BAFF-R in the pathogenesis of SLE role and significance of the condition for the occurrence of SLE,development and treatmentevaluation of new ideas,methods,And evaluation indicators.【Objective】1.Evaluation VCR and CTX group treatment of clinical efficacy and safety.2.Study the influence of BAFF and BAFF-R which VCR combined CTX treatment possible mechanism of SLE.【Methods】1.Carry on a experiment which is two centers,random,contraposition and single blind.2.Clinical research:there were three groups:high dose CTX,VCR combinedlow dose CTX and VCR combined high dose CTX.Evaluate two kinds of treatmentthe clinical efficacy and safety.The index of clinical efficacy is SLEDAI,ESR,C3and ALB.3.Experimental study:ELISA detect serum levels of BAFF.Real-time quantitative RT-PCR detect peripheral blood mononuclear cells in BAFF and BAFF-Rexpression.【Results】1.The level of SLEDAI and ESR descende dobviously.The level of C3and ALBescalated obviously.The three groups was ndiscriminat.2.Compared the three groups,VCR combined low dose CTX treatment grouphas low ratio of side effect.3.Compared the three groups,VCR combined low dose CTX treatment group ofperipheral blood mononuclear cells in BAFF were not statistically significant.4.Compared the three groups,VCR combined low dose CTX treatment group ofperipheralbloodmononuclearcellsinBAFFandBAFF-Rexpressionlevelswerenotstatisticallysignificant.【conclusion】1.Combined low dose cyclophosphamide treatment group can significantly improve the condition and the side effect can’t raised.2.Combined low dose cyclophosphamide treatment group can significantly receded the level of BAFF and BAFF-RmRNA.