贝利尤单抗治疗系统性红斑狼疮的疗效分析

doi:10.13481/j.1671-587X.20250624

Abstract

Abstract:

Objective To explore the clinical application effect of belimumab in the treatment of systemic lupus erythematosus （SLE） and its influence on cluster of differentiation （CD40） and cluster of differentiation 40 ligands （CD40L） expression in the peripheral blood， and to provide a theoretical basis for the effective treatment of SLE. Methods A retrospective analysis was conducted on the clinical data of 150 patients with SLE admitted to our hospital， and they were divided into conventional treatment group （n=78， standard treatment plan） and belimumab group （n=72， standard treatment plan + belimumab） according to the treatment methods. The therapeutic effects and adverse reactions were compared. The clinical symptoms， organ involvement， disease activities， prednisone doses， the expression levels of CD40 and CD40L mRNA in peripheral blood mononuclear cells， and the levels of immunology-related indicators before and after treatment were analyzed. Results Compared with conventional treatment group， the total effective rate， complement C3 and complement C4 levels in the belimumab group were significantly increased after treatment （P<0.01 or P<0.001）， while the proportion of renal involvement， the SLE disease activity index-2K （SLEDAI-2K） score， the dosage of prednisone， immunoglobulin G （IgG） level and the expression levels of CD40 and CD40L mRNA in peripheral blood mononuclear cells were decreased （P<0.01 or P<0.001）. There was no statistically significant difference in the total incidence of adverse reactions between two groups during treatment period （P>0.05）. Conclusion Belimumab can increase the effective rate of SLE treatment， reduce disease activity， decrease the involvement of the kidneys and the dose of hormones， and has good safety； its mechanism of action may be related to down-regulating the expression of CD40 and CD40L in peripheral blood and improving the immune function.

Key words: Systemic lupus erythematosus, Belimumab, Prednisone, Cluster of differentiation 40, Cluster of Differentiation 40 ligands

CLC Number:

R593.241

Jing FENG,Li RAO,Jiali SHI,Jing SUN,Hairu XIE. Efficacy analysis of belimumab in treatment of systemic lupus erythematosus[J].Journal of Jilin University(Medicine Edition), 2025, 51(6): 1679-1686.

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References 26

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Group	n	Gender [n（η/%）]		Age（x±s，year）	Course（x±s，month）	BMI（x±s，kg·m^-2）	SLEDAI-2K score （x±s）	Dosage of prednisone（x±s，mg·d^-1）
Group	n	Male	Female	Age（x±s，year）	Course（x±s，month）	BMI（x±s，kg·m^-2）	SLEDAI-2K score （x±s）	Dosage of prednisone（x±s，mg·d^-1）
Conventional treatment	78	7（8.97）	71（91.03）	33.79±4.35	30.96±4.41	22.15±1.39	12.81±2.53	23.75±4.49
Belimumab	72	5（6.94）	67（93.06）	34.57±4.08	32.05±5.18	21.86±1.14	13.15±2.37	24.38±4.71
χ²/t		0.210		1.130	1.391	1.390	0.848	0.839
P		0.647		0.260	0.166	0.166	0.398	0.403

Group	n	Excellent	Effective	No effective	Total effective
Conventional treatment	78	3（3.85）	52（66.67）	23（29.49）	55（70.51）
Belimumab	72	17（23.61）	47（65.28）	8（11.11）	64（88.89）
χ²		-	-	-	7.711
P		-	-	-	0.005

Group	n	Fever		Musculoskeletal joint involvement		Skin mucous membrane involvement		Kidney involvement
Group	n	Before treatment	After treatment	Before treatment	After treatment	Before treatment	After treatment	Before treatment	After treatment
Conventional treatment	78	17（21.79）	0（0.00） ^*	32（41.03）	0（0.00） ^*	26（33.33）	5（6.41） ^*	29（37.18）	21（26.92）
Belimumab	72	19(26.39)	0（0.00） ^*	36（50.00）	0（0.00） ^*	29（40.28）	3（4.17） ^*	29（40.28）	5（6.94）^**△
χ²		0.433	—	1.217	—	0.778	0.061	0.152	10.429
P		0.510	—	0.270	—	0.378	0.805	0.697	0.001

Group	n	SLEDAI-2K score		Dosage of prednisone（mg·d^-1）
Group	n	Before treatment	After treatment	Before treatment	After treatment
Conventional treatment	78	12.81±2.53	7.95±1.96 ^*	23.75±4.49	10.62±2.81 ^*
Belimumab	72	13.15±2.37	6.21±1.41 ^*^△	24.38±4.71	7.14±1.59 ^*^△
t		0.848	6.196	0.839	9.231
P		0.398	<0.001	0.403	<0.001

Group	n	CD40 mRNA		CD40L mRNA
Group	n	Before treatment	After treatment	Before treatment	After treatment
Conventional treatment	78	1.08±0.26	0.73±0.20 ^*	0.79±0.22	0.50±0.14 ^*
Belimumab	72	1.10±0.25	0.51±0.13 ^*^△	0.75±0.21	0.36±0.08 ^*^△
t		0.479	7.916	1.137	7.437
P		0.632	<0.001	0.257	<0.001

Efficacy analysis of belimumab in treatment of systemic lupus erythematosus

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Group	n	IgG		Complement C3		Complement C4
Group	n	Before treatment	After treatment	Before treatment	After treatment	Before treatment	After treatment
Conventional treatment	78	16.91±3.85	12.41±2.71 ^*	0.65±0.15	0.78±0.22 ^*	0.11±0.02	0.16±0.04 ^*
Belimumab	72	16.38±4.13	9.46±1.84 ^*^△	0.62±0.14	0.93±0.27 ^*^△	0.11±0.03	0.24±0.07 ^*^△
t		0.813	7.735	1.263	3.742	0.000	8.676
P		0.417	<0.001	0.208	<0.001	1.000	<0.001