关键词: 狼疮性肾炎, 硼替佐米, 临床疗效, 不良事件

Abstract:

Ｏｂｊｅｃｔｉｖｅ：Refractory lupus nephritis (LN) is still a nodus for clinicians. The aim of this paper is to investigate the efficacy and safety of bortezomib combined with glucocorticoids for refractory lupus patients.
Ｍｅｔｈｏｄｏｌｏｇｙ：Five refractory lupus patients aged from 21 to 43 years (femal 4 and male 1) with biopsyproven (class Ⅳ 4 and classⅤ+Ⅳ 1) were recruited. They received bortezomib therapy for four cycles (13 mg/m2 BSA, as an intravenous bolus on days 1, 4, 8, and 11 in a 21day cycle) and glucocorticoids (methylprednisolone 05 g/d intravenously for 3 days, followed by oral prednisone 06 mg/kg/d for 4 weeks and gradually tapered to 10 mg/d). The proteinuria, albumin, serum creatinine, immunological parameters and adverse effects were observed.
Ｒｅｓｕｌｔｓ：After 2～4 cycles of bortezomib treatment，4 patients received partial remission with  SLEDAI decreased from 12～16 to 4～8. Patients had a decline of proteinuria and elevated albumin after treatment. The SCr were decreased in 3 patients with abnormal SCr before therapy. The autoantibodies and complements were also improved. The adverse events were grade 1～2，included transient thrombocytopenia, gastrointestinal symptom and  acroanesthesia. Follow up 6～24 months, 3 patients received complete remission and 1 patient received partial remission. Only 1 patient received renal replacement therapy because of massive proteinuria and progressive renal function.
Ｃｏｎｃｌｕｓｉｏｎ：Bortezomib combined with glucocorticoids can effectively reduce proteinuria，improve renal function and depress autoantibodies with well tolerance and mild adverse events. It is may be an alternative therapy for LN treatment which needed deeply investigation.