Abstract:Objective To observe the therapeutic effects of DNA immunoadsorption (DNA-IA) and plasma exchange (PE) for the treatment of children severe systemic lupus erythematosus (SLE)in order to provide an evidence for the optimization of clinical applications further. Methods Sixty children who were first diagnosed as severe SLE and hospitalized in department of pediatrics of West China Second Hospital of Sichuan University and in department of internal medicine of Chengdu Hospital of Armed Police Sichuan General Team from September 2008 to December 2016 were collected. The patients were divided into two groups (30 case each):group IA and group PE. Whole blood perfusion technique (hemoditoxifier was DNA230 immunoabsorbent column) and membrane type plasmapheresis technique were used for the treatment of DNA-IA and PE, respectively. SLE disease activity index(SLEDAI), autoantibody titer, blood routine, biochemistry and the changes in immunological indexes before and after treatment were evaluated. Results The treatment was completed successfully in 60 children, and the clinical symptoms and signs improved significantly in 58 cases. The side effects of group IA were less and milder than that in group PE in which cerebral edema and pulmonary edema occurred in one case 6 hours after procedure, and one case died of severe pancreatitis. Compared with pre-treatment, SLEDAI decreased significantly after treatment in two groups (all P<0.05), while there was no significant difference between the two groups(P>0.05). Compared with pre-treatment, anti-double stranded DNA (dsDNA) antibody titer and antinuclear antibody (ANA) titer decreased significantly after treatment in both two groups (all P<0.01). Compared with pre-treatment, immunoglobulin (Ig) G, IgA, IgM, complements C3 and C4 improved significantly after treatment in both two groups(all P<0.05). Compared with group PE, anti-dsDNA antibody titer decreased, and IgM and complement C3 level rose after treatment in group IA(all P<0.05), while there were no statistical differences in other indexes(all P>0.05). There were no significant differences in the white blood cell count, platelet count and hemoglobin level before and after treatment between two groups(all P>0.05). In group IA, the number of platelets decreased to 56×10⁹/L after treatment in one case. Creatinine, urea nitrogen and 24-hour urine protein quantitation after treatment in two groups improved significantly compared with pre-treatment(all P<0.05), but there were no significant differences in them for pairwise comparison. Conclusion Both DNA-IA and PE are effective for the treatment of severe SLE. DNA-IA is better than PE for the improvement of anti-dsDNA antibody titer and complement C3 level. The side reaction of IA is less and lighter than PE. Plasma is relative lack in many parts of our country at present, but DNA-IA is not limited by this.