摘要
目的:比较霉酚酸酯(MMF)与间断环磷酰胺(CTX)静脉冲击疗法治疗重症过敏紫癜性肾炎(HSPN)的临床疗效。方法:39例重症HSPN患者,分别采用激素联合MMF治疗(MMF组,n=21),或采用激素联合CTX间断静脉冲击治疗(CTX组,n=18)。MMF剂量1.5或2g/d,诱导疗程均≥6个月;CTX剂量为0.6～0.75g/m2·体表面积,每月静脉滴注一次,6个月后改为每3个月一次。两组患者基础病情无差异。MMF组失访1例,CTX组失访4例,退出2例。其余患者随访时间≥12个月。疗效指标包括完全缓解、部分缓解、蛋白尿和血尿缓解及复发率。比较观察两组治疗的临床疗效和副作用。结果:①临床缓解率:治疗6、9和12个月时完全缓解率MMF组高于CTX组,分别为25%vs8.3%、40%vs25%和55%vs25%(P>0.05)。部分缓解率两组相近,分别为40%vs50%、45%vs33.3%和40%vs33.3%(P>0.05)。总缓解率分别为65%vs58.3%、85%vs58.3%和95%vs58.3%(P>0.05)。②尿蛋白变化:MMF组尿蛋白缓解率高于CTX组,治疗6个月和12个月时两组完全缓解率分别为45%vs16.7%(P>0.05)和70%vs25%(P<0.05)。③尿红细胞变化:MMF组治疗6个月时血尿缓解率高于CTX组(45%vs16.7%),12个月时两组相近(65%vs66.7%)。④肾功能:MMF组6例治疗初有肾功能不全,5例治疗3个月降至正常;1例6个月降至正常。CTX组4例治疗3个月降至正常。随访末两组SCr均正常。⑤副作用:MMF组并发带状疱疹和上呼吸道感染各1例。CTX组2例明显消化道症状,各有1例并发带状疱疹、细菌性肺炎、白细胞下降、肝酶升高、脱发。1例因副作用严重而退出。⑥复发:MMF组2例(10.5%),CTX组5例(41.7%)。结论:激素联合MMF治疗重症HSPN缓解率高于CTX静脉冲击疗法,能更有效降低蛋白尿和血尿。MMF副作用发生率和复发率均低于CTX疗法。
Objective：To compare the clinical efficaey of mycophenolate mofetil （MMF） versus pulse cyclophosphamide （CTX） therapy in the treatment of severe Henoch-Schoniein purpura nephritis （HSPN）. Methodology：Thirtynine patients with severe HSPN proven clinically and histologically were enrolled into this study. They were divided into MMF and CTX groups. MMF group included 21 cases who were treated with MMF at a dosage of 1.5 - 2.0 g/d. CTX group enrolled 18 cases who were geven 0. 6 - 0. 75 g/m^2- BSA monthly for 6 months and then quarterly. The patients in both groups also received methylprednisolone （MP） pulse therapy followed by oral predenisone. The two groups were matched in age and severity of renal damage. One in MMF group and six patients in CTX group were lost follow-up, and two patients in CTX group were dropped out during the therapy. The other patients were followed up for more than 12 months. The clinical efficacy and side effects were compared between the two groups. Results：①Clinical efficacy： The total remission rate （complete remission and partial remission） in the 6^th, 9^th and 12^th month after MMF therapy were 65% , 85% and 95% , while only 58.3% , 58.3% and 58.3% in CTX group respectively. The complete remission rate in MMF vs CTX Group were 25% vs 8.3% , 40% vs 25% and 50% vs 25% （ P 〉 0. 05 ） , respectively. ②The complete remission rate of proteinuria （ ≤0.4 g/24h） in the 6^th and 12^th month after the MMF vs CTX therapy were 45% vs 16. 7% and 70% vs 25% （ P 〈0. 05 ） ,respectively. ③The complete remission rate of Urinary RBC count（ ≤10 × 10^4/ml） in the 6^th month after the MMF vs CTX therapy were 45% vs 16. 7%. ④Renal function：5 of six cases recovered renal function after treatment with MMF for 3 months, and one for 6 months. In CTX group, four cases recovered their renal function after treatment for 3 months. ⑤Side effects： There were no significant side effects in both groups. Only one was dropped out owing to severe side effect in CTX group. ⑥Recurrence： Two cases relapsed in MMF group, while five cases relapsed in CTX group. Conclusion：The combination therapy of MMF and steroid was more effective than CTX pulse therapy in patients with severe HSPN. MMF could have more efficacy in reducing proteinuria, haematuria with fewer complications and lower relapse.
出处
《肾脏病与透析肾移植杂志》
CAS
CSCD
2005年第6期508-513,共6页
Chinese Journal of Nephrology,Dialysis & Transplantation
关键词
过敏紫癜性肾炎
霉酚酸酯
环磷酰胺
治疗
Henoch-Schonlein purpura nephritis mycophenolate mofetil cyclophosphamide treatment
