吗替麦考酚酯联合皮质类固醇激素治疗特发性局灶节段性肾小球硬化的临床观察

The clinical observation of the effect of mycophenolate mofetil combined with corticosteroid hormone on idiofocal segmental glomerular sclerosis.

目的探讨吗替麦考酚酯(MMF)联合皮质类固醇激素与环磷酰胺(CTX)联合皮质类固醇激素治疗特发性局灶节段性肾小球硬化(I-FSGS)的临床疗效及副反应。方法将2004—2006年郑州大学第一附属医院肾内科住院治疗的30例I-FSGS患者随机分为2组:MMF联合皮质类固醇激素组(治疗组)与CTX联合皮质类固醇激素组(对照组),每组各15例。比较治疗组与对照组4,6,12个月24h尿蛋白定量、血清白蛋白、肌酐清除率。结果治疗4个月后,治疗组和对照组均较治疗前24h尿蛋白定量明显减少(P<0.05),血清白蛋白和肌酐清除率均明显升高(P<0.05)。6个月及12个月时,治疗组与对照组相比,24h尿蛋白定量明显减少(P<0.05),血清白蛋白和肌酐清除率明显升高(P<0.05),总缓解率亦显著增加(P<0.05)。治疗组主要副反应为消化道症状(2例),对照组主要副反应为肝脏损害(3例)、骨髓抑制(2例)、消化道症状(6例)。结论MMF联合皮质类固醇激素治疗I-FSGS临床疗效优于CTX联合皮质类固醇激素,且副反应较小。

Objective To observe the clinical curative effect and side-effect of MMF plus corticosteroid hormone compared with cyclophosphamide （CTX）plus corticosteroid hormone for idio-focal segmental glomerular sclerosis （I-FSGS）. Methods Thirty patients with I-FSGS confirmed by renal biopsy in the Nephrology Department,the First Affiliated Hospital of Zhengzhou University from 2004 to 2006 were randomly divided into two groups - 15 patients in each group：MMF combined with corticosteroid hormone as therapy group, and CTX combined with corticosteroid hormone as control group. The two groups were compared on urine protein in 24 hours, serum albumin and creatinine clearance rate （Ccr）. Results There were significant differences（ P 〈 0.05 ） in the decrease of urine protein in 24 hours ,the increase of serum albumin and creatinine clearance rate（Ccr） between two groups after 4 months＇ treatment. Compared with control group, the urine protein in 24 hours decreased significantly（ P 〈 0. 05 ）, while serum albumin and creatinine clearance rate （Ccr）increased enormously（ P 〈 0. 05 ）in therapy group after 6 and 12 months. The main side effect in therapy group was digestive symp- toms （ 2 cases ）, while in control group liver injury （ 3 cases）, bone marrow depression （ 2 cases） and digestive symptoms （ 6 cases）. Conclusion The effect of MMF plus corticosteroid hormone on I-FSGS is obviously superior to CTX plus corticosteroid hormone, and with less side-effect.