摘要
目的:比较激素联合不同免疫抑制剂治疗高危因素特发性膜性肾病临床疗效,以探讨合理的治疗方案。方法:随机将2001年5月至2011年5月在我院确诊的46例高危因素的特发性膜性肾病患者分为3组,分别给予甲基泼尼松龙与环磷酰胺、环孢素A或霉酚酸酯中的一种联合使用,总疗程12个月,比较各组治疗方案的临床疗效。结果:(1)治疗前3组患者血压、血肌酐和24 h尿蛋白定量比较无显著性(P>0.05)。(2)甲基泼尼松龙+环磷酰胺、甲基泼尼松龙+环孢素A和甲基泼尼松龙+霉酚酸酯总缓解率分别为53.3%、80.0%和43.8%,甲基泼尼松龙+环孢素A与其余两组比较总缓解率较高,且有显著性(P<0.05);甲基泼尼松龙+环磷酰胺和甲基泼尼松龙+霉酚酸酯两组之间总缓解率无明显差异(P>0.05)。结论:激素联合免疫抑制剂治疗高危因素的特发性膜性肾病,可明显地提高患者的蛋白尿缓解率,其中甲基泼尼松龙+环孢素A总缓解率较高,且优于其他免疫抑制剂,但其复发率较高,肾脏药物不良反应大,临床选用时需谨慎。
Objective： To compare the efficacy of different therapies with risk factors for idiopathic membranous nephropathy（IMN） patients,and to discuss their rationality.Methods： 46 cases with high risk factors diagnosed IMN in our hospital from May 2001 to May 2011,were randomly divided into three groups,given methylprednisolone（MP） with cytoxan（CTX）,cyclosporin A（CsA） or mycophenolate mofetil（t MMF）.Compare the clinical efficacy of various treatment programs in 12 months.Results：（1）Before treatment,the three groups of patients with blood pressure,serum creatinine and 24 h urinary protein had no significant difference（P0.05）.The overall response rate of MP＋CTX,MP＋CsA and MP＋MMF were 53.3 %,80.0 % and 43.8%.The overall response rate of MP＋CsA was higher than other two groups and has a significant difference（P0.05）;Overall response rate had no significant difference between MP＋CTX and MP＋MMF（P0.05）.Conclusion： Glucocorticoid and immunosuppressive therapy with risk factors for idiopathic membranous nephropathy,can significantly improve the response rate of patients with proteinuria,MP ＋CsA has a higher overall response rate,and superior to other immunosuppressive agents,but the recurrence rate and kidney toxicity was high,clinical selection need to be cautious.
出处
《现代生物医学进展》
CAS
2013年第14期2710-2712,2721,共4页
Progress in Modern Biomedicine
关键词
膜性肾病
糖皮质激素
免疫抑制剂
高危因素
Membranous nephropathy
Glucocorticoids
Immunosuppressant
Risk factors
