摘要
目的比较麦考酚吗乙酯(MMF)与间断环磷酰胺(CTX)静脉冲击疗法治疗原发性难治性肾病综合征(IRNS)的临床疗效、副作用和复发率。方法62例IRNS患者分别采用MMF联合激素治疗(MMF组,n=31),或采用CTX间断静脉冲击联合激素治疗(CTX组,n=31)。二组患者均给予甲基泼尼松龙静脉冲击后口服泼尼松,MMF剂量1.0g或1.5g/d,疗程均≥6个月;CTX剂量为12～20mg/kg,每月静滴1次,6个月后改为每3月1次,疗程≥12个月,通过观察患者尿蛋白量、血白蛋白(ALB)、血肌酐(Scr)、血胆固醇(Tch)的变化,比较二组缓解率、副作用发生率及复发率。结果①疗效:完全缓解率MMF组(54.8%)高于CTX组(35.5%)(P<0.05),总缓解率MMF组(90.3%)显著高于CTX组(67.7%)(P<0.01)。MMF组较CTX组尿蛋白明显下降及血浆白蛋白回升,二组比较差异有统计学意义(P<0.01)。②副作用:MMF组(9.7%)的副作用率显著低于CTX组(54.8%)(P<0.01)。③复发:MMF组(9.7%)复发率显著低于CTX组(41.9%)(P<0.01)。结论与CTX静脉冲击治疗相比较,MMF联合激素治疗IRNS缓解率高,能更有效降低蛋白尿,副作用发生率和复发率低,是目前治疗IRNS一种较好的方法。
Objective To compare the clinical efficacy of mycophenolate mofetil（MMF） and pulse cyclophosphamide （CTX） therapy in treatment of idiopathic refractory nephrotic syndrome（IRNS）. Methods 62 patients with proven clinical and histological IRNS were enrolled into this study. They were divided into MMF and CTX groups . MMF group included 31 eases who were treated with MMF at a dosage of 1.0-1.5g/d. 31 eases who were given 12-20mg/ kg monthly for 6 months and then the dosage was changed to once a quarter months. The patients enrolled in CTX group received methylprednisolone（MP） pulse therapy followed oral prednisone. The quantity of urinary protein,serum albumin,serum creatinine, serum cholesterol were measured. The remission rate, drug- related side effect and recurrence rate were compared between the two groups. Results ①Curative effect： The complete remission rate of MMF group （54.8%） was higher than that of CTX group （P〈0.05）. The total remission rate of MMF group （90.3%） was significantly higher than that of CTX group （P〈0.01）. MMF group reduced the quantity of urinary protein increment of serum albumin as compared with CTX group with statistical significance（P〈0.01）. ②Side effect.. The adverse reactions rate of MMF group（9.7%）was significantly lower than that of CTX group （P〈0.01）. ③Recurrence： The recurrence rate of MMF group（9.7%） was significantly lower than that of CTX group （P〈0.01）. Conclusion The combination therapy of MMF and steroid was more effective than CTX pulse therapy in patients with IRNS. MMF could have more efficacy in reducing proteniuria with fewer side effect and lower recurrence rate.
出处
《中国煤炭工业医学杂志》
2008年第6期802-804,共3页
Chinese Journal of Coal Industry Medicine
关键词
肾病综合征
原发性难治性
麦考酚吗乙酯
环磷酰胺
idiopathic refractory nephrotic syndrome
mycophenolate mofetil
cyclophosphamide
