犀角地黄汤加减联合血浆置换治疗急重型系统性红斑狼疮的疗效与机制研究

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）、24 h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、24 h尿蛋白、Scr、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。

Study on the Effect and Mechanism of Modified Xijiao Dihuang Decoction Combined with Plasma Exchange in Treating Acute Severe Systemic Lupus Erythematosus

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), interleukin-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.