目的 探討免疫球蛋白聯(lián)合嗎替麥考酚酯膠囊治療重癥系統(tǒng)性紅斑狼瘡的臨床療效。方法 選擇2013年12月-2014年12月上海國際醫(yī)學(xué)中心收治的重癥系統(tǒng)性紅斑狼瘡的患者80例，隨機分為對照組和治療組，每組各40例。對照組口服嗎替麥考酚酯膠囊，起始劑量為3粒/次，2次/d；3個月后為2粒/次，2次/d；6個月后根據(jù)患者的病情用量為2~3粒/d，同時不使用其他免疫抑制劑。治療組患者在對照組的基礎(chǔ)上靜脈注射靜注人免疫球蛋白（pH 4）0.4 g/kg，1次/d，連續(xù)使用3 d，每月重復(fù)1次。兩組治療時間為6~12個月。觀察兩組治療前后系統(tǒng)性紅斑狼瘡疾病活動指數(shù)（SLEDAI）、血清白蛋白、24 h尿蛋白、IgG、血肌酐（Scr）的變化情況。比較兩組ANA陽性例數(shù)、A-dsDNA陽性例數(shù)、貧血例數(shù)的變化情況。結(jié)果 治療后，兩組SLEDAI評分、24 h尿蛋白、IgG、Scr水平均顯著降低，血清白蛋白升高，同組治療前后差異有統(tǒng)計學(xué)意義（P<0.05）；治療后治療組SLEDAI評分、24 h尿蛋白、IgG、Scr低于對照組，血清白蛋白高于對照組，兩組比較差異具有統(tǒng)計學(xué)意義（P<0.05）。治療后，兩組ANA陽性例數(shù)、A-dsDNA陽性例數(shù)、貧血例數(shù)均顯著減少，同組治療前后差異有統(tǒng)計學(xué)意義（P<0.05）；治療組治療后ANA陽性例數(shù)、A-dsDNA陽性例數(shù)、貧血例數(shù)少于對照組，兩組比較差異具有統(tǒng)計學(xué)意義（P<0.05）。對照組和治療組不良反應(yīng)發(fā)生率分別為82.5%、47.5%，兩組比較差異有統(tǒng)計學(xué)意義（P<0.05）。結(jié)論 免疫球蛋白聯(lián)合嗎替麥考酚酯膠囊治療重癥系統(tǒng)性紅斑狼瘡具有良好的效果，能夠改善患者的病情，具有一定的臨床推廣應(yīng)用價值。

Objective To investigate the clinical effect of immunoglobulin combined with Mycophenolate Mofetil Capsules in treatment of severe systemic lupus erythematosus. Methods Patients (80 cases) with severe systemic lupus erythematosus in Shanghai International Medical Center from December 2013 to December 2014 were randomly divided into control and treatment groups, and each group had 40 cases. The patients in the control group were po administered with Mycophenolate Mofetil Capsules, starting dosage of 3 grains/time, twice dailiy; After 3 months, 2 grains/time, twice daily; the dosage was adjusted to 2-3 grains/d according to the illness state after 6 months, and other immunosuppressants were not used. The patients in the treatment group were iv administered with Human Immunoglobulin (pH 4) for Intravenous Injection on the basis of the control group, 0.4 g/kg, once daily, consecutive for 3 d, repeat once monthly. The patients in two groups were treated for 6-12 months. The changes of SLEDAI, serum albumin, 24 h urinary protein, IgG, and Scr in two groups before and after treatment were compared. The changes of ANA positive cases, A-dsDNA positive cases, and anemia cases in two groups were compared. Results After treatment, SLEDAI, 24 h urinary protein, IgG, and Scr in two groups were significantly reduced, and serum albumin in two groups were significantly increased, and the difference was statistically significant in the same group (P<0.05). After treatment, SLEDAI, 24 h urinary protein, IgG, and Scr in the treatment group were lower than those in the control group, and serum albumin was higher than that in the control, and there were differences between two groups (P<0.05). ANA positive cases, A-dsDNA positive cases, and anemia cases in two groups were reduced, and the difference was statistically significant in the same group (P<0.05). After treatment, ANA positive cases, A-dsDNA positive cases, and anemia cases in the treatment group were less than those in the control group, with significant difference between two groups (P<0.05). The incidences of adverse reactions in the control and treatment groups were 82.5% and 47.5%, and there were differences between two groups (P<0.05). Conclusion Immunoglobulin combined with Mycophenolate Mofetil Capsules has clinical curative effect in treatment of severe systemic lupus erythematosus, can improve the patient's condition, which has a certain clinical application value.