环孢素A、强的松和抗凝联合治疗特发性膜性肾炎的回顾性分析

A RETROSPECTIVE ANALYSIS ON CYCLOSPORINE A, PREDNISONE AND ANTICOAGULATIVE THERAPY IN PATIENTS WITH IDIOPATHIC MEMBRANOUS NEPHRITIS

比较单用强的松、强的松＋环磷酰胺、强的松＋环孢素Ａ３种不同方法治疗特发性膜性肾炎的疗效，进行３～１０ａ的随访总结。方法测定患者的２４ｈ尿蛋白定量及血清肌酐值以评定治疗效果。结果单用强的松治疗组３０例，完全缓解１１例（３７％），部分缓解７例（２３％），有效率６０％；强的松＋环磷酰胺组２４例，完全缓解１０例（４２％），部分缓解４例（１６％），有效率５８．３％；强的松＋环孢素Ａ组２６例，完全缓解１９例（７３％），部分缓解４例（１５％），有效率８８．５％。在随访中，３组患者的两年复发率分别为３３．３％，３５．７％，３４．８％，其差别无显著性。结论建议在特发性膜性肾炎的治疗上，对激素无效者可加用环孢素Ａ治疗以提高疗效。

PURPOSE To compare the efficacy of cyclosporine A with prednisone alone, cyclophosphamide plus prednisone in patients with idiopathic membranous nephritis, and to observe the recurrence during 3～10 years follow up. METHODS The quantity of 24h protienuria, serum creatine value were investigated in 80 patients. RESULTS In the prednisone alone group of 30 cases, a complete remission of protienuria (CR) was in 11 and a partial remission (PR) in 7, the remission rate was 60%. In the cyclophosphamide plus prednisone group of 24 patients, CR was in 10 and PR in 4 with the remission rate 58.3%. In the cyclosporine A group of 26 cases, CR 19, PR 4, and the remission rate was 88.5%. There was no significant difference in 2-years recurrent rates of all the three groups. CONCLUSIONS It is suggested that cyclosporine A should be given in patients with idiopathic membranous nephritis, who showed no response to corticosteriod therapy.