Observation Of Short-term Efficacy Of Gradient Decreasing Dose Of Methylprednisolone Pulse Therapy Intreatment Of Lupuscrisis

Systemic lupuse rythematosus is a chronic inflammatory disease?At present,the number of patients suffering from this disease is 1 million in our country,the prevalence rate is high,close to 1/1000.Lupus crisis is a life-threatening situation.The consequences of illness to patients,families and society is a disastrous.High-dose corticosteroid can quickly improve the condition,but the adverse reactions cannot be ignored.1.1 ObjectiveTo observe the short-term efficacy and safety of methylprednisolone(MP)pulse gradient-decrease therapy in the treatment of lupuscrisis compare to the traditional MP pulse gradient-decrease therapy.1.2 SourcePatients who had been diagnosed as lupus crisis according to the ACR 1997 classification criteria and had systemic lupus erythematosus disease activity index(SLEDAI)>14.They received treatment in our hospital from September 1st,2009 to September 31 st,2014 and have complete follow-up data(about 6 weeks).1.3 MethodsThese patients have no contraindication in using steroid.They were divided into two groups.The data of 28 lupus crisis patients who received MP pulse gradient-decrease treatment(GroupA)and 30 lupus crisis patients who got conventional MP pulsetherapy(GroupB)were analyzed retrospectively.Group A had been used MP with 500~1000 mg/d and decreasing dosage every 3~5 days step by step(each time 50%)for induction of remission.Group B had been used MP with 500~1000 mg/d every 3~5 days and with low dose {1 mg/(kg·d)} in the off period.Two groups of patients were treated with comprehensive treatment,including cyclophosphamide,intravenous immunoglobulin and other auxiliary symptomatic treatment.The age of patients,course of disease,SLEDAI score,levels of ESR,clinical remission rate,recurrence rate,remission time and adversere action rate were observed and analyzed after 6 weeks' treatment.1.4 Statistical methodsSPSS 19.0 statistical software.We used t test and ?2 test for statistical analysis.The difference was statistically significant with P < 0.05.1.5 Efficacy evaluation criteriaThe effective rate,recurrence rate,onset time and adverse reaction rate of treatment after 6 weeks were analyzed.The evaluation criteria of curative effect:(1)Complete remission: SLEDAI score < 5;hemoglobin,platelet,liver function and BNP turn to normal value,Urinary protein < 0.5 g /24 h,the renal function was normal or nearly normal;X-ray/ CT results in patients with severe lupus pneumonitis / pulmonary hemorrhage showed complete absorption.(2)Partial relief: SLEDAI score reduce to 5 to 14;Hemoglobin > 60 g / L;Platelets > 50 × 109 / L;The liver function and BNP were normal or close to normal(if abnormal,the current abnormal value should decrease more than 50%);Urinary protein? 0.5 g / 24 h,but decreased more than 50 %;Renal function is normal or close to normal(if abnormal,the current abnormal value should decrease more than 50%);X-ray/CT results in patients with severe lupus pneumonitis / pulmonary hemorrhage suggested that lung effusion absorption > 50 %.(3)Invalid: the score of SLEDAI was more than 14;The clinical manifestations of crisis were not relieved.The patients became aggravation or death;Urinary protein,hemoglobin,platelet,liver and kidney function and BNP did not improve or deteriorate after treatment.(4)Recurrence: patients become aggravated or died after recover;SLEDAI score more than 14.1.6 Results(1)The clinical remission rate has no statistical significance between two groups(P>0.05),but Group A used less time to get clinical remission(P <0.05)and has obvious lower recurrence rate(3.57%)than that Group B(27%,P <0.05).(2)Two therapies were both curative,but Group A has a flagrant contrast in the ESR and SLEDAI score after treatment(P <0.05).(3)Group A received high ercumulative dosage of glucocorticoid compared with Group B(P <0.05),but there was nosignificant difference in side-effects between two groups(P >0.05).The incidence of adverse events did not significantly differ between two groups(P >0.05).The incidence of electrolyte disorders in Group A was significantly higher than that in Group B(P <0.05).The incidence of infection and other adverse events did not significantly differ between two groups(all P >0.05).(4)The results showed that there was no difference on mortality in two groups.But the mortality was positively correlated with the number of organs involved in the disease: The more organs involved,the higher the mortality.1.7 Conclusion:The MP pulse gradient-decrease therapy effects quickly,has lower recurrence rate and better clinical outcomes in the treatmen to flupuscris is than conventional MP pulse therapy.For patients with lupus crisis,positive and reasonable control of multiple organ failure,can improve the survival rate of patients.we should also pay attention to electrolytic index in patients during the therapy.