摘要
目的观察吗替麦考酚酯（MMF）联合氟伐他汀（LESCOL）治疗原发性难治性肾病综合征（IRNS）的临床疗效、副作用和复发率。方法62例IRNS患者随机分为两组，一组采用MMF联合联合氟伐他汀治疗（MMF＋LESCOL组，n=31），另一组采用CTX间断静脉冲击治疗（CTX组，n=31）。两组患者均给予甲基泼尼松龙静脉冲击后口服泼尼松，MMF剂量1.0或1．5g／d，疗程均／〉6个月，氟伐他汀40mg，每晚一次口服，疗程〉19个月；CTX剂量为12～20mg／kg，每月静脉滴注一次，6个月后改为每3月一次，疗程≥12个月，通过观察患者尿蛋白量、血白蛋白（ALB）、血肌酐（Scr）、血胆固醇（TC）的变化，比较两组缓解率、副作用发生率及复发率。结果疗效：①完全缓解率MMF＋LESCOL组（54．8％）显著高于CTX组（35．5％），P〈0．01，显著缓解率MMF＋LESCOL组（25．8％）显著高于CTX组（16．1％）（P〈0．01，总缓解率MMF＋LESCOL组（90．3％）高于CTX组（67．7％），P〈0．05。MMF＋LESCOL组尿蛋白明显下降及血浆白蛋白回升与CTX组相较有显著性差异（P〈0．01）。②副作用：副反应率MMF＋LESCOL组（9．7％）显著低于CTX组（51．6％），P〈0．01。③复发：复发率MMFq-LESCOL组（9．7％）显著低于CTX组（32．3％），P〈0．01。结论与CTX静脉冲击治疗相比较，MMF联合LESCOL治疗IRNS缓解率高，能更有效降低蛋白尿，副作用发生率和复发率低，是目前治疗IRNS一种较好的方法。
Objective To observe the clinical efficacy of mycophenolate mofetil（MMF） and fluvastatin（LESCOL） in the treatment of Idiopathic Refractory Nephrotic Syndrome（IRNS）. Method Sixty- two patients with IRNS proven clinically and histologically were enrolled into this study. They were divided into MMF and LESCOL group or CTX group . MMF and LESCOL group included 31 cases who were treated with MMF at a dosage of 1.0 ~ 1.5g/d, for at least 6 months. They also received LESCOL 40mg/d for at least 9 months. CTX group enrolled 31 cases who were geven cyclophosphamide 12 - 20mg/kg monthly 6 months and then quarterly 2 quarters. All patients in both groups also received methylprednisolone（MP） pulse therapy followed by oral prednisone . The quantity of urinary protein , serum albumin, serum creatinine, serum cholesterol was meaxured. The remission rate, drug - rela - ted side effect and recurrence rate were compared between the two groups. Results （~）Cur- ative effect：The complete remission rate of MMF ＋ LESCOL group （54. 8% ） was significantly higher than that of CTX group（35.5% ） ,P 〈 0.01. The signal remission rate of MMF ＋ LESCOL group （25. 8% ） was significantly higher than that of CTX group （ 16. 1% ）, P 〈 0. 01. The total remission rate of MMF ＋ LESCOL group（90. 3% ） was higher than tha, of CTX group（67.7% ） ,P 〈0. 05. MMF ＋ LESCOL group showed decrease the quantity of urinary protein increase of serum albumin as compared with CTX group with statistical significance. P 〈 0.01 （2）Side effect：The adverse reactions rate of MMF ＋ LESCOL group （9.7%）was significantly lower than that of CTX group （51.6 % ）, P 〈 0. 01. （3）Recnrrence：The recurrence rate of MMF ＋ LESCOL group （9. 7% ） was significantly lower than that of CTX group （32. 3% ）, P 〈 0. 01. Conclusion The combination therapy of MMF and LESCOL was more effective than CTX pulse therapy in patients with IRNS. MMF and LESCOL could have more efficacy in reducing proteniuria with fewer side effect and lower recurrence rate.
