甲基泼尼松龙联合环磷酰胺冲击治疗重症紫癜性肾炎18例疗效观察

Effects of combination pulse therapy with methylprednisolone and cyclophosphamide on severe Henoch- Schonlein purpura nephritis

目的观察甲基泼尼松龙(MP)联合环磷酰胺(CTX)静脉冲击治疗重症紫癜性肾炎(HSPN)的疗效。方法对临床表现为血尿和蛋白尿型、急性肾炎综合征型、肾病综合征型、急进性肾炎型,病理改变为Ⅲ级、Ⅳ级、Ⅵ级的18例重症HSPN患儿,给予MP+CTX静脉冲击治疗,随访5～36个月。结果冲击治疗后9例完全缓解,6例部分缓解,3例无效,总有效率为83.33%;治疗后24h尿蛋白定量、尿系列微量蛋白、血尿素氮、血肌酐明显下降,治疗前后相比差异有统计学意义(P<0.05)。结论MP+CTX静脉冲击治疗重症HSPN近期疗效好,不良反应少,是临床治疗重症HSPN的重要手段。

Objective To observe the effect of combination therapy with intravenous pulse methylprednisolone （MP） and cyclophosphamide （CTX） on severe Henoch-Schonlein purpura nephritis （HSPN） . Methods Eighteen children with severe HSPN whose clinical manifestation were hematuria and proteinuria, acute nephritic syndrome, nephrotic syndrome, rapidly progressive glomerulonephritis and whose pathological classifications were graded Ⅲ, Ⅳ, Ⅵ, were treated by combination therapy with intravenous pulse MP and CTX. The patients had been followed from 5 months to 36 months. Results After combination therapy with pulse MP and CTX , nine patients were completely in remission, six patients were partly in remission, and three patients were invalid. The total effective rate was 83.33%. After treatment, the 24 h urinary protein quantitative, urinary serial small protein, blood urea nitrogen and serum creatinine were significantly decreased （P 0.05）. Conclusions Combination therapy with intravenous pulse MP and CTX has better short-time effect and few side-effects on severe HSPN. It is an important treatment of severe HSPN.