摘要
目的：首次应用双倍剂量雷公藤多甙（ＴⅡ）治疗原发性肾病综合征，前瞻性观察其疗效。方法：１８例单纯肾病综合征患者（８例ＩｇＡＮ，４例ＩｇＭＮ，６例ＭｓＰＧＮ）均服用ＴⅡ２ｍｇ／（ｋｇ．ｄ）４周，观察蛋白尿变化及副反应。结果：１５例肾病综合征获得完全缓解，总缓解率达８３３％，其中ＩｇＡＮ（７例），ＩｇＭＮ（３例），ＭｓＰＧＮ（５例）的缓解率分别为８７５％，８３３％，７５０％。１５例中１２例在服药２周内获得缓解，部分对皮质激素不敏感者双倍剂量ＴⅡ仍然有效，无效仅２例。尿蛋白平板电泳分析标明对ＴⅡ敏感者尿蛋白呈高度选择性，而对ＴⅡ不敏感者含有较多大分子及小分子量蛋白质。所有患者均能耐受双倍剂量ＴⅡ，消化道反应及对肝细胞的损伤作用轻微，无一例出现严重白细胞减少。分别有２例患者在ＴⅡ迅速减量及继发上呼吸道感染后肾病综合征复发，但重新采用大剂量ＴⅡ或延长治疗时间仍有效。结论：双倍剂量ＴⅡ对临床表现为单纯肾病综合征，组织学病变为系膜增生的多种肾小球疾病具有良好的疗效。
OBJECTIVE TⅡ( a multiglycoside extract from Tripterygium Wilfordii Hook f) has being widely used in treating many kinds of primary and secondary glomerulonephritis in a dose of 1 mg/(kg·d). Double dosage of TⅡ ( 2 mg/kg·d -1 ) was firstly used in eighteen patients with primary nephrotic syndrome ( NS ) and the short term responsiveness was evaluated in the present study. METHODOLOGY Eighteen nephrotic patients without hematuria and renal insufficiency were included, of whom 8 patients were IgA nephropathy(IgAN), 4 IgM nephropathy (IgMN) and 6 mesangial proliferative glomerulonephritis (MsPGN). TⅡ was given in a dose of 2 mg/(kg·d) for at least 4 weeks. Urinary protein excretion were studied weekly and side effects of TⅡ were observed. RESULTS (1)Complete remission of nephrotic syndrome was observed in 15 patients(83.3%) within the first 4 weeks of treatment, and most of them (12 patients, 80%) obtained complete remission within the first 2 weeks. Remission rates of IgAN, IgMN and MsPGN were 87.5%, 83.3% and 75% respectively. Remission was also observed in five steroid resistant patients. (2)Patients responsive to TⅡ tended to have higher urinary protein selectivity and fewer low molecular weight urinary proteins( as determined by SDS PAGE) than those non responsives. (3) All patients tolerated TⅡ well, gastrointestinal symptoms were not obvious. Temporal mild elevations of SGPT and SGOT were found in 22.2% and 5.5% of the patients, non of them developed leukopenia. (4) Relapse occurred in 2 cases who reduced TⅡ dosage rapidly and 2 cases who complicated by upper respiratory tract infection , but remission could be induced again with the reuse of TⅡ in the same dosage. CONCLUSION Double dosage of TⅡ can increase the remission rates of nephrotic IgAN, IgMN and MsPGN without any obvious side effects and can be the first choice in the treatment of these patients.
出处
《肾脏病与透析肾移植杂志》
CAS
CSCD
1997年第3期210-214,共5页
Chinese Journal of Nephrology,Dialysis & Transplantation
关键词
肾病综合征
雷公藤多甙
治疗
Tripterygium Wilfordii Hook f nephrotic syndrom side effect
