目的 探讨犀角地黄汤加减联合血浆置换(PE)治疗急重型系统性红斑狼疮(SLE)的疗效及作用机制.方法 纳入我院180例SLE患者,随机数字表法分为A、B、C三组.A组采取环磷酰胺冲击治疗、B组采取PE治疗,C组采取PE联合犀角地黄汤.比较三组治疗前后的症状评分、SLEDAI评分、补体C3、血沉(ESR)、抗ds-DNA抗体、血清肌酐(Scr)、血清胱抑素(CsyC)、谷草转氨酶(AST)、谷丙转氨酶(ALT)、24h尿蛋白、人干扰素-r(IFN-r)、白介素-10(IL-10)、BAFF因子,统计3组治疗总有效率及不良反应发生率.结果 B、C组治疗后各观察点的症状评分、SLEDAI评分、ESR、ds-DNA抗体、24h尿蛋白、Ser、CsyC、AST、ALT、血清BAFF均低于A组(P＜0.05).C组治疗后各观察点的IFN-r-IL-10+与IFN-r+ IL-10+亚群所占百分率低于A、B组(P＜0.05).B、C组治疗后各观察点的C3高于A组(P＜0.05).B组与C组治疗总有效率为分别为90.0％、93.3％,均高于A组的71.7％(P＜0.05).C组不良反应发生率为10.0％,低于A组与B组(P＜0.05,P＜0.01).结论 PE可去除血浆中有害成分、抑制炎症反应,联合犀角地黄汤可进一步扶助正气、解毒化瘀,改善机体免疫功能,达到增效减毒目的,效果更理想.%Objective To observe the effects of modified Xijiao Dihuang decoction combined with plasma exchange (PE) in treating acute sever systemic lupus erythematosus (SLE) and explore the mechanism.Methods A total of 180 patients with SLE in our hospital were selected as study subjects.By the random number table method,the patients were divided into group A,group B and group C.Group A was given cyclophosphamide pulse therapy,while group B was treated with PE,and group C was treated with PE combined with Xijiao Dihuang decoction.The symptom scores,SLEDAI scores,complement C3,erythrocyte sedimentation rate (ESR),anti Ds-DNA antibody,serum creatinine (Scr),serum cystain (CsyC),aspertate aminotransferase (AST),alanine transaminase (ALT),24 h urine protein,human Interferon gamma (IFN-r),intedeukin-10 (IL-10) and BAFF were compared between groups before and after treatment.The total efficiency and the incidence rates of adverse reactions were statistically analyzed.Results The symptom scores,SLEDAI scores,ESR,ds-DNA antibody,24 h urine protein,Scr,Csyc,AST,ALT and serum BAFF in group B and group C at different time points after treatment were lower than those in group A (P＜0.05).The proportions of IFN-r-IL-10+subset and IFN-r+ IL-10+ subset in group C at different time points after treatment were lower than those in group A and group B (P＜0.05).The C3 in group B and group C at different time points after treatment were higher than those in group A (P＜0.05).The total effective rates of group B and group C (90.0％,93.3％) were higher than that in group A (71.7％) (P＜0.01).The incidence rate of adverse reactions in group C (10.0％) was lower than that in group A and group C (P＜0.05,P＜0.01)).Conclusion Plasma exchange can remove harmful elements in plasma.The combined therapy with Xijiao Dihuang decoction can maintain vital Qi,detoxify and remove stasis and improve immunity,playing an effect-enhancing and toxicity-reducing role.Besides,the effect is more ideal.
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