狼疮性肾炎WHO-V型14例临床治疗体会

Clinical Treatment of 14 Patients with Class V Lupus Nephritis

目的探讨狼疮性肾炎(WHO-V型,膜性)临床治疗。方法狼疮性肾炎(WHO-V型)统一采用糖皮质激素pred加环磷酰胺CTX治疗,病理表现具有明显活动性损伤者给予甲基强的松龙冲击治疗,足疗程治疗不能缓解者给予环胞霉素CsA治疗。结果采用以pred+CTX为基础方案治疗LN的总有效率为11/14(78.57%),对上述治疗未完全缓解者,使用CsA治疗完全缓解为42.86%,部份缓解为57.14%,总有效率为100.00%。结论pred+CTX(和/或MP)治疗狼疮性肾炎(WHO-V型型)有效,临床病理具有冲击指征者,MP冲击治疗可有效控制疾病的活动度,对以上治疗无效者,应用CsA可大幅度提高蛋白尿的缓解率。

Objective To investigate the efficacy of different treatments for lupus nephritis （LN）. Methods Prednisone plus cyclophosphamide was administered to 14 cases with LN pathologically confirmed and intensive methylprednisolone to the cases with severe active renal lesions based on the above treatment. The cyclosporine A （CsA） was added to the cases who had not responded to sufficient course of continuous glucocorticosteroid plus cyclophosphamide. Results Total response rate was 78.75% （11/14） in glucocorticosteroid plus cyclophosphamide group. For the non-remission cases, after using CsA,the complete remission rate and partial remission rate was 42.86% and 57.14% respectively, the total response rate were 100%. Conclusions Administration of glucocorticosteroid and cyclophosphamide is effective for most patients with LN. Intensive methylprednisolone therapy can significantly suppress disease activity. CsA was found more effective in reducing proteinuria for the non-remission patients to above treatment.