摘要
目的 探讨不同剂量环磷酰胺（CTX）对弥漫增殖性狼疮肾炎各亚型的疗效差异.方法 回顾性分析133例肾活检确诊的,接受糖皮质激素＋CTX规律治疗的Ⅳ型（Ⅳ-G 和Ⅳ-S亚型）或Ⅳ＋V型狼疮肾炎患者的基线Scr、尿蛋白量（24 h）、CTX剂量方案及预后情况.对各型各剂量组的预后情况进行比较.结果 患者6个月内CTX平均累积剂量为（11.1±4.1）g.以6 g和12 g为界,将6个月时的CTX累积剂量分为高（〉12 g）、中（〉6～12g）、低（≤6 g）3个剂量组.与低剂量组比较,高剂量组Ⅳ＋Ⅴ型、活动或慢性（A/C）患者完全缓解率有改善的趋势（Ⅳ＋Ⅴ型：67%比40%,P=0.314;A/C：43%比0%,P=0.212）,但未能明显改善Ⅳ-S和IV-G亚型的完全缓解率（Ⅳ-S亚型：67%比50%,P=0.548;Ⅳ-G亚型：65%比70%,P=0.560）.高剂量组总不良反应高于低剂量组,但差异无统计学意义（51%比37%,P=0.224）.结论 激素＋高剂量CTX的治疗方案可提高Ⅳ＋Ⅴ型及慢性病变患者的缓解率.
Objective To investigate the efficacy differences of different doses of cyclophosphamide（CTX）among subcategories of diffuse proliferative lupus nephritis（LN）. Methods Clinical data of 133 LN patients diagnosed by renal biopsy with class IV or class IV ＋V who were treated with corticosteroid plus CTX were analyzed retrospectively. The baseline Scr, 24 h urine protein, CTX dosages and prognosis were compared among different dosages for each subcategory. Results The average cumulative dose of CTX within 6 months was（11.1 4.1）g. The high dose group was 〉12 g, the medium dose group was 〉6-12 g and the low dose group was ≤6 g. Compared to low dose group, high dose CTX increased the remission rate of class Ⅳ ＋Ⅴ（67% vs 40%, P=0.314）and chronic renal lesion（43% vs 0%, P=0.212）, but such enhancement was not obvious in class Ⅳ（Ⅳ-S： 67% vs 50%, P=0.548, Ⅳ-G： 65% vs 70%, P= 0.560）. Difference of overall adverse reactions was not significant between high dose group and low dose group（51% vs 37% ,P=0.224）. Conclusion Corticosteroid plus high dose CTX may improve the remission rate of patients with class IV ＋ V and chronic renal lesions.
出处
《中华肾脏病杂志》
CAS
CSCD
北大核心
2010年第8期573-577,共5页
Chinese Journal of Nephrology
关键词
狼疮肾炎
环磷酰胺
预后
Lupus nephritis
Cyclophosphamide
Prognosis
