Synchronised therapy and high-dose cyclophosphamide in proliferative lupus nephritis
Synchronised therapy and high-dose cyclophosphamide in proliferative lupus nephritis
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DOI：
10.1002/jca.10020
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发表时间：
2002-01-01
影响因子：
1.5
通讯作者：
Danieli, G
中科院分区：
文献类型：
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作者：
Danieli, MG;Palmieri, C;Danieli, G
本开放性研究的目的是比较环磷酰胺（Cyc）大剂量治疗狼疮性肾炎患者的血浆置换（PP）的结局和副作用。该研究涉及28名连续患者。所有患者均符合ACR修订的SLE标准，并接受了合格的肾活检。I组患者接受同步治疗（PP. 50 ml/kg，然后脉冲Cyc。750 mg/m2，每月重复6个月），而在组II中，他们只接受间歇性Cyc推注（相同剂量）。根据标准化方案在患者记录中收集数据。患者平均随访4年。采用Kaplan-Meier估计的生存曲线（[S（t）]）分析无病生存期。在6个月的治疗期结束时，与组II（31%）相比，组I（75%）中有统计学显著数量的患者完全缓解（P < 0.02）。而在长期随访中，这些百分比相似（41% vs. 50%，P = n.s.）。两组的主要功能和免疫学参数均显示正常化。肾脏预后不良的风险与肾炎发作时血清肌酐水平升高显著相关（P < 0.05）。我们记录了I组感染并发症的发生率较高。这项研究报告说，同步治疗是有用的，在增殖性狼疮肾炎患者诱导更快的缓解。然而，在长期随访分析中，它并不上级常规治疗。积极的结果应该通过长期维持治疗来加强。(C)2002年威利-利斯。Inc.
The aim of this open study was to compare the outcomes and side effects of plasmapheresis (PP) in patients with Proliferative lupus nephritis treated with cyclophosphamide (Cyc) boluses. The study involved 28 consecutive patients. All of the patients met the ACR modified criteria for SLE and underwent a qualifying renal biopsy. In group I, patients were treated with synchronised therapy (PP. 50 ml/kg, followed by pulse Cyc. 750 mg/m(2), repeated monthly for 6 months), whereas in group II, they were given only intermittent Cyc boluses (at the same dosage). The data were collected in the patients' records according to a standardised protocol. Patients were followed-up for a mean of 4 years. The disease-free Survival was analysed Using Kaplan-Meier estimated survival curves ([S(t)]). At the end of the 6-month treatment period, a statistically significant number of patients in group I (75%) was in complete remission in comparison to group II (31%) (P < 0.02). whereas at long-term follow-up, these percentages were similar (41% vs. 50%, P = n.s.). The main functional and immunological parameters showed a normalisation in both groups. The risk of a poor renal outcome significantly correlated with high serum creatinine levels at the onset of nephritis (P < 0.05). We documented a higher rate of infectious complications in group I. This study reports that synchronised therapy is useful in inducing a faster remission in patients with proliferative lupus nephritis. However, it is not superior to conventional therapy at long term follow-up analysis. Positive results should be reinforced by a long-term maintenance therapy. (C) 2002 Wiley-Liss. Inc.