双冲击疗法治疗寡免疫复合物型新月体肾炎

The effects of methylprednisolone and cyclophosphamide pulse therapy on patients with pauci-immune crescentic glomerulonephritis

本文为国内首次报道运用甲基强的松龙及环磷酰胺双冲击疗法治疗15例寡免疫复合物型新月体肾炎,取得一定疗效,无明显副反应。治疗3个月,66.7%患者肾功能及尿检异常明显改善。长期随访的11例中(平均随访27.8个月),仅3例仍需透析治疗,4例肾功能保持正常,无一例死亡。双冲疗法对肾组织中浸润细胞均有明显抑制作用,治疗后 CD4^+、CD8^+、单核细胞(CD68^+)及增殖细胞核抗原(PCNA^+)细胞数均有明显下降;治疗前肾脏局部 CD4/CD8的比值、单核细胞及 PCNA^+细胞浸润的多少,可作为判断治疗反应的一项指标。

To investigate the effects of pulse ther- apy with methylprednisolone and monthly intravenous cyclophosphamide(MP+CTX) in patients with pauci-immune rapid pro- gressive glomerular nephritis(RPGN-Ⅲ), fifteen patients with RPGN-Ⅲ(>50% cres- cents)received MP+CTX therapy.The changes of renal function(including serum creatinine,proteinuria and hematuria)and infiltrating CD4^+,CD8^+,CD68^+ and prolif- erating cell neuclear antigen-PCNA^+ cell levels in glomeruli and interstitium were ob- served.At three monthes after MC+CTX treatment,66.7% of patients improvement in renal function and urinary analysis.The numbers of infiltrating CD4^+,CD8^+,CD68^+ and PCNA^+ cell in glomeruli and intersti- tium were significantly suppressed by MP+ CTX therapy.Eleven cases fulled up for more than six monthes(averages 27.8 mon- thes),the serum creatinine kept normal in four of them.Only three patients needed dialysis and none of them died.Conclussion: Our data indicate that the MP+CTX is a safe,well tolerated and effective regimen for treatment of patients with RPGN-Ⅲ.The degree of infiltrating CD4^+,CD68^+ and PC- NA^+ cells in renal tissue may be a indicator of MP+CTX therapy for RPGN-Ⅲ.