关键词: 关键词：重症狼疮性肾炎 , 双重血浆置换 , 临床疗效

Abstract:

ABSTRACT   Objective: To investigate the clinical efficacy and safety of double filtration plasmapheresis （DFPP） accompanied with corticosteroid in patients with severe lupus nephritis (LN).  Methodology: Thirty one patients (19 females and 12 males, average age of 24.4?10.9 y) with severe LN including class Ⅳ (n=19)、Ⅲ(n=1)、Ⅴ+Ⅳ(n=8)、Ⅴ+Ⅲl(n=2) and Ⅴ(n=1) were enrolled in this study. Among them, 22 cases showed rapidly progressive glomerulonephritis（RPGN） with elevated serum creatinine（SCr）（300.6?185.6?mol/L）, and 11 of them needed renal replacement therapy. DFPP was performed with two-fold plasma volume on each session using membrane type plasma component separator (EC50W and EC20W，Asahi Kasei Kuraray，Japan). Results: (1) Clinical efficacy: After DFPP treating 2.6 times（1～3）for each patient, their SLE-DAI was reduced significantly from (16.0?3.5) to (9.7?1.5) (P<0.01）and SCr was decreased from (300.6?185.6)??mol/L to (247.5?168.0) ?mol/L (P<0.05）. Six patients got off dialysis respectively. Gross hematuria disappeared in 4 patients and there was no change in proteinuria.  (2)Immunologic parameters: After DFPP，the levels of serum IgG were decreased from (10.9?5.2) g/L to (4.6?2.0) g/L （P<0.01）, and the titers of anti-dsDNA antibody were significantly declined, while the levels of complements and lymphcytes had no change. (3)Follow up:  31 patients were followed up for 1～29 months（10.1?6.4）. 6 patients achieved complete remission, 18 had partial remission and 6 developed to ESRD with maintenance hemodialysis. (4)Adverse effect:  one had catheter infection and one had hypotension episodes during DFPP treatment.  Conclusion: DFPP could decrease activity of SLE and improve renal function through rapidly and effectively clearance of antibodies in severe LN. So DFPP accompanied with corticosteroid is an effective therapeutic method for severe LN. However, the right indication, suitable course and dosage of DFPP will need to deeply investigate.

Key words: Keywords: , severe lupus nephritis, double filtration plasmapheresis, therapy