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目的探讨肿瘤坏死因子 ( TNF)检测在大剂量环磷酰胺静脉冲击治疗狼疮性肾炎 ( L N)中的价值。方法用EL ISA双抗体夹心法检测 5 1例 L N患者环磷酰胺静脉冲击治疗 ( IV- CTX)前后血清和尿 TNF水平。结果活动期 L N患者血清和尿 TNF水平显著高于稳定期 ( P<0 .0 0 1)。血清 TNF水平与血沉呈显著正相关 ( n=5 1,r=0 .386 ,P<0 .0 5 )。轻度肾功不全患者血清 TNF水平显著高于肾功正常者 ( P <0 .0 5 ) ,尿 TNF水平与 2 4h尿蛋白呈显著正相关 ( n=5 1,r=0 .42 1,P <0 .0 1) ,IV- CTX加强的松治疗能显著降低 L N患者尿 TNF水平。结论 TNF产生异常参与了 L N的发病过程 ,血清和尿 TNF的检测有助于监测狼疮活动和肾损害程度。IV- CTX可能通过抑制单核 /巨噬细胞和 T细胞产生 TNF而取得疗效 ,IV- CTX方案应根据病情 (包括 TNF水平 )调整
Objective To investigate the value of tumor necrosis factor (TNF) detection in the treatment of lupus nephritis (L N) with high dose cyclophosphamide. Methods Serum and urinary TNF levels were measured before and after cyclophosphamide intravenous shock therapy (IV-CTX) in 51 patients with L N by sandwich ELISA. Results Serum and urinary TNF levels in patients with active L N were significantly higher than those in stable patients (P <0.01). Serum TNF levels were positively correlated with erythrocyte sedimentation rate (n = 5 1, r = 0.386, P <0.05). The level of serum TNF in patients with mild renal insufficiency was significantly higher than that in patients with normal renal function (P <0.05). The level of urinary TNF was positively correlated with 24-hour urinary protein (n = 5 1, r = 0.42 1, P <0.01), IV-CTX enhanced pine therapy can significantly reduce the level of urinary TNF in LN patients. Conclusion Abnormal production of TNF is involved in the pathogenesis of L-N, and the detection of serum and urinary TNF may be helpful in monitoring the activity of lupus and the degree of renal damage. IV-CTX may achieve efficacy by inhibiting the production of TNF by monocytes / macrophages and T cells. The IV-CTX regimen should be adjusted according to the disease (including TNF level)