摘要
目的:特发性膜性肾病(IMN)是成人肾病综合征的常见原因之一,但是膜性肾病的治疗仍是临床上的一个难题。本文前瞻性地观察了单用雷公藤多苷(TW)和TW联合小剂量泼尼松(TW+P)治疗IMN的临床疗效和安全性。方法:经肾活检并结合临床诊断为IMN患者,尿蛋白>3.5 g/24h。随机分为2组。TW组:TW120 mg/d口服,至3个月完全缓解者,减量为维持剂量(60 mg/d),持续至12个月。3个月时部分缓解或无效者,TW 120 mg/d可延长至6个月,再减量为60 mg/d维持至12个月。TW+P组:TW用药同上,同时服用泼尼松30mg/d,8周后逐渐减量(每2周隔日减5 mg),10 mg隔/日维持至12个月。结果:共84例患者入组,其中TW+P治疗组43例,TW治疗组41例。治疗3个月,TW+P组3例(6.98%)完全缓解,29例(67.4%)部分缓解,有效率为74.4%;TW组无一例完全缓解,21例(51.2%)患者部分缓解。有效率为51.2%。治疗6个月,TW+P组13例(30.2%)完全缓解,21例(48.8%)部分缓解,有效率为79.1%;TW组仍为21例(51.2%)部分缓解,无一例完全缓解,有效率为51.2%。治疗12个月,TW+P组16例(37.2%)完全缓解,17例(39.5%)部分缓解,有效率为76.7%,而TW组2例(4.88%)达到完全缓解,16例(39%)部分缓解,有效率为43.9%。TW+P组有效率和完全缓解率均明显高于TW组。不良反应的发生率两组之间无明显差异。起病年龄轻和小管间质病变较轻的IMN患者对治疗反应较好。治疗过程中两组患者血清肌酐均保持稳定。结论:TW能有效减少膜型肾病患者蛋白尿。TW+P治疗的疗效明显优于单用TW。患者耐受性好,不良反应少,是治疗IMN的有效方法。
Objective：Idiopathic membranous nephropathy（IMN） is a common cause of nephrotic syndrome in adults.Its management is still controversial.We conducted a prospective randomized clinical trial to evaluate the therapeutic efficacy of combined regime of tripterygium wilfordii（TW） with steroid（P）,and TW monotherapy in patients with IMN. Methodology：Eighty-four cases of biopsy-proven IMN were enrolled in this trial,with proteinuria 〉3.5 g/24h.They were randomized divided into two groups,TW＋P group： 43 patients,TW 2 mg/kg,daily for 3 months,and then tapered to maitanence dose of 1 mg（kg·d） for 12 months,and prednisone [0.5 mg（kg·d）] for 2 months with taper doses of 10 mg alternate-day for 12 months.TW group： 41 patients,TW 2 mg（kg·d） daily for 3 months and 1 mg（kg·d） for 12 months. Results：The remission rates were 74.4%,79.1%,and 76.7% after 3,6,and 12 months treatment in TW＋P group,While the TW group were 51.2%,51.2%,and 43.9%.The complete remission rates in the TW＋P group was 37.2% at 12 ...months treatment but only 4.88% in the TW group（P〈0.01）.Serum creatinine was stable in two groups.No severe adverse events were observed during the course of treatment. Conclusion：A 12-month course of treatment revealed that TW is a useful therapy to reduce proteinuria in patients with IMN.The effect is significantly higher in TW＋P group then TW monotherapy.TW＋P is a promising therapeutic option for patients with IMN.
出处
《肾脏病与透析肾移植杂志》
CAS
CSCD
北大核心
2009年第4期303-309,共7页
Chinese Journal of Nephrology,Dialysis & Transplantation
基金
全军"十一.五"重点课题(06G040)
江苏省自然科学基金重点课题(BK2007718)
南京军区"十一.五"重点课题(06Z025)
关键词
特发性膜性肾病
雷公藤多苷
激素
治疗
idiopathic membranous nephropathy tripterygium wilfordii（TW） steroid
