霉酚酸酯与环磷酰胺治疗重症IgA肾病的临床对照

Mycophenolate mofetil therapy versus cyclophosphamide treatment in patients with sever IgA nephropathy

目的:比较霉酚酸脂(MMF)与环磷酰胺(CTX)静滴治疗重症IgA肾病的临床疗效。方法:29例IgA肾病患者分别采用激素联合MMF治疗(MMF组,n=15),或采用激素联合CTX静注治疗(CTX组,n=14)。MMF剂量为1.5g/d,诱导疗程均≥6个月;CTX剂量为0.4g,隔日1次静脉滴注,总量≤8g。两组患者基础病情无差异,随访时间≥12个月,疗效指标包括临床缓解率、24h尿蛋白定量和血脂变化。观察两组的临床疗效和副作用。结果:①临床缓解率:治疗12个月时,MMF组临床,总有效率高于CTX组,分别为81%和57%(P<0.05);②MMF组24h尿蛋白明显低于CTX组(0.6±0.3和1.4±0.8,P<0.05);③MMF组血脂明显降低(P<0.05)。而CTX组无变化;④MMF组副作用的发生率明显低于CTX组(13%和43%,P<0.05)。结论:激素联合MMF治疗重症IgA肾病,临床缓解率高于CTX静脉滴注疗法,能更有效降低蛋白尿,改善血脂水平,且副作用发生率低于CTX疗法。

To compare the clinical efficacy of mycophenolate mofetil （MMF） with that of cyclophosphamide （CTX） in the treatment of sever IgA nephropathy.Methods：Forty-one patients with sever IgA nephropathy were enrolled into this study and were divided into MMF and CTX groups. MMF group included 15 cases that were treated with MMF at a dosage of 1.5 g/d. CTX group enrolled 14 cases that were given intravenous drip 0.4 g/2d and the total dosage was less than 8g. These patients were followed up for more than 12 months. The clinical efficacy and side effects were compared between the two groups.Resuhs：①Clinical remission rate in the 12th month was 81% in MMF therapy and it was 57%in CTX group. The difference of the clinical remission rate between the two groups was significant （P〈0.05） .②The concentration of proteinuria in 24h in MMF group was lower than that in CTX group （P〈0.05） .③After the therapy, the level of blood-lipid decreased obviously in MMF group, but it did not changed in CTX group （P〈 0.05） .④The side effect in both groups were 13% （ MMF group） vs 43% （CTX group） （P〈0.05） .Conclusion：The combination therapy of MMF and steroid was more effective than CTX intravenous drip in treatment of sever lgA nephropathy and with fewer side effects.