课件：治疗进展陈顺乐.ppt

SLE与感染相关的病死率 Matthew E. Clin Rheumatol (2007) 26:663–670 SLE治疗总结 早期诊断、早治疗是改善预后的前提 规范治疗的个体化治疗是改善预后的关键 狼疮重要脏器损害、难治性狼疮是改善预后的难点和重点 SLE患者评估 （SLEDIA，BILAG，OUT等） 轻度SLE 中度SLE 重症SLE 小剂量强的松+抗疟药/植物药 标准剂量激素（1-2mg/kg）抗疟药、免疫抑制剂 高剂量激素冲击治疗（2mg/kg）/ＩＶＣＴＸMMF/CSA/IGIV Y N Y Y N 难治性SLE 维持治疗 诱导缓解 综合治疗（激素/免疫抑制剂/靶向生物制剂/免疫吸附/干细胞移植） 脏器评估（如肾脏活检） 预防感染 Ren Ji Hospital (Pudong , East ) THANKS THANK YOU SUCCESS * * 可编辑 * * CC * * Supplemental Nephritis 10-year survival Prior to widespread dialysis in 1969—close to zero Wallace/Dubois (1981)—30% Esdaille (1989)—73% Recent—Most live 10 years, high % loss at 10-25 years * * * * Patients assigned to the high-dose group received 8 IV CYC pulses within a year (6 monthly pulses followed by 2 quarterly pulses). The initial CYC dose was 0.5 gm/m2 of body surface area; subsequent doses were increased by 250 mg according to the white blood cell count nadir measured on day 14 ([16]), with a maximum of 1,500 mg per pulse. Patients assigned to the low-dose group received 6 fortnightly IV CYC pulses at a fixed dose of 500 mg. The use of mesna was left to the decision of the physician. In both treatment arms, AZA (2 mg/kg/day) was started 2 weeks after the last CYC injection and continued at least until month 30 after study inclusion. For cases of AZA-related toxicity, the dosage was reduced to 1 mg/kg/day. Patients who did not tolerate this AZA dosage were dropped from the trial. Figure 6. Kaplan-Meier analysis of the probability of absence of severe infection. Patients were randomized to a low-dose (LD; ) or a high-dose (HD; ) regimen of intravenous cyclophosphamide, followed by azathioprine treatment. The hazard ratio for severe infection in the low-dose group compared with the high-dose group was 0.50 (95% confidence interval 0.17-1.47; P = 0.20). Numbers shown along the abscissa are the number of patients at risk in each group. Analysis was by intent-to-treat. Figure 5. Kaplan-Meier analysis of the probability of renal flare. Patients were randomi