目的 研究羟氯喹联合利妥昔单抗治疗系统性红斑狼疮的临床疗效。方法 选择2017年1月—2019年12月榆林市第二医院的系统性红斑狼疮患者71例作为研究对象。用抽签法随机将患者分为对照组（36例）和观察组（35例）。对照组iv利妥昔单抗注射液，100 mg/次，1次/周。观察组在对照组基础上口服硫酸羟氯喹片，0.4 g/次，2次/d。两组均治疗4周。观察两组患者的临床疗效，同时比较两组治疗前后的系统性红斑狼疮疾病活动指数（SLEDAI）评分、24 h尿蛋白、血肌酐、血清白蛋白和炎性因子水平。结果 治疗后，观察组的有效率为91.43%，明显高于对照组的69.44（P<0.05）。治疗后，两组的SLEDAI评分、血肌酐及24 h尿蛋白水平明显降低，血清白蛋白水平明显升高（P<0.05）；且观察组的SLEDAI评分、血肌酐及24 h尿蛋白水平明显低于对照组，血清白蛋白水平明显高于对照组（P<0.05）。治疗后，两组血清白细胞介素（IL）-4、IL-17和单核细胞趋化蛋白-4（MCP-4）水平明显降低（P<0.05），且观察组的血清IL-4、IL-17和MCP-4水平明显低于对照组（P<0.05）。结论 羟氯喹联合利妥昔单抗能改善系统性红斑狼疮患者的免疫功能，降低血清IL-4、IL-17和MCP-4水平，具有一定的临床推广应用价值。

Objective To study the effect of hydroxychloroquine combined with rituximab on the patients with systemic lupus erythematosus. Methods A total of 71 patients with systemic lupus erythematosus in Yulin No. 2 Hospital from January 2017 to December 2019 were selected as study subjects. Patients were randomly divided into control group (36 cases) and observation group (35 cases) by lottery. Patients in the control group were iv administed with Rituximab Injection, 100 mg/time, once per week. Patients in the observation group po administered with Hydroxychloroquine Sulfate Tablets on the basis of control group, 0.4 g/time, twice daily. Both groups were treated for 4 weeks. After treatment, the clinical effects were observed, and SLEDAI score, the levels of 24 h urinary protein, serum creatinine and albumin, and inflammatory factors in two groups before and after treatment were compared. Results After treatment, the effective rate of the observation group was 91.43%, which was significantly higher than 69.44% of the control group (P<0.05). After treatment, SLEDAI score, serum creatinine and 24 h urinary protein levels were serum creatinine and 24 h urine protein levels in the observation group were significantly lower than those in the control group, but serum albumin levels were significantly higher than those in the control group (P<0.05). After treatment, serum levels of IL-4, IL-17 and MCP-4 in two groups were significantly decreased (P<0.05), and serum IL-4, IL-17 and MCP-4 levels in the observation group were significantly lower than those in the control group (P<0.05). Conclusion Hydroxychloroquine combined with rituximab can improve the immune function of patients with systemic lupus erythematosus, and reduce the serum levels of IL-4, IL-17 and MCP-4, which has certain clinical application value.

R976

陕西省重点研发项目（2018SF-168）