吗替麦考酚酯治疗狼疮肾炎的疗效及安全性研究

Three-year Follow-up Study of Lupus Nephritis Treated with Mycophenolate Mofetil

【目的】探讨吗替麦考酚酯(MMF)治疗狼疮肾炎的疗效以及安全性。【方法】选择本院确诊为狼疮肾炎,经环磷酰胺(CTX)治疗疗效不佳或出现副作用的患者,共19例,其中男性2例,女性17例,使用MMF治疗,所有的患者开始MMF治疗前都进行了肾活检。并进行36个月的随访,在0,3,6,12,24,36个月观察患者尿蛋白、血清补体水平以及肾功能的变化,并观察出现的副作用及时间。【结果】患者治疗后3个月尿蛋白开始减少,到6个月时差异有显著性(P<0.05)。患者血清补体水平治疗后与治疗前相比,明显上升,差异有显著性(P<0.05)。治疗12月后,患者总的缓解率为73.7%(14/19)。19例患者中有6例患者治疗前有肾功能不全,经过治疗后有4例肾功能恢复正常,1例与治疗前无明显变化,1例进展为尿毒症期。【结论】MMF对狼疮肾炎有效,副作用少,安全性较好。

[Objective] To investigate the efficacy and safety of mycophenolate mofetil （MMF） in the treatment of lupus nephritis （LN）. [Methods] Nineteen patients （2 male, 17 female） with LN, who had failed cyclophosphamide treatment or to withdraw because of adverse reactions, were enrolled in this study. After proven LN by biopsy, all the patients were treated with MMF, and the administration maintained about 36 months. The proteinuria, serum complement and renal function were assessed at 0,3,6,12,24,36 months, while side effects and their time were observed. [Results]The proteinuria decreased at the third month, and there was a significant difference （ P 〈0.05） at the sixth month. The level of serum complement increased remarkably after treatment, with a significant difference （ P 〈0.05）. After treated for 12 months, the total remission rate of patients was 73.7%（14/19）. The renal function of 4 cases in 6 patients with renal failure recovered after MMF treatment, one case had no change, one case progressed into uremia.