环磷酰胺联合糖皮质激素治疗膜性肾病的临床疗效

Treatment of idiopathic membranous nephropathy with combined prednisone and cyclophosphamide

目的探讨环磷酰胺联合糖皮质激素(激素)治疗特发性膜性肾病的临床疗效。方法回顾性分析2007年至2009年行肾活检明确诊断为膜性肾病16例患者的临床资料。16例患者中,男12例,女4例;年龄46～72(52.0±3.0)岁。肾功能(血肌酐)正常。所有患者均采用环磷酰胺联合泼尼松治疗18个月:泼尼松0.5mg.kg-1.d-1,然后逐渐减量至15mg/d维持;环磷酰胺0.6～0.8g.m-2.月-1静脉滴注,每月1次,6个月后改为每3个月1次。观察治疗前后24h尿蛋白定量、血浆白蛋白、血肌酐,并计算完全缓解率、部分缓解率、显效率及有效率。结果 24h尿蛋白定量于治疗3、6、12及18个月时分别为(5.2±2.1)、(3.6±1.8)、(2.7±1.5)和(1.4±1.1)g/24h,与治疗前〔(6.5±3.2)g/24h〕比较均有明显减低(P均<0.05),并且随着疗程的延长进一步减低。血浆白蛋白水平于治疗3、6、12及18个月时分别为(33.0±1.2)、(35.0±0.6)、(36.0±0.3)、(35.0±0.7)g/L,与治疗前〔(26.0±0.8)g/L〕比较均有明显升高(P均<0.05)。血肌酐水平治疗后无明显变化(P>0.05)。有效率于治疗3、6、12及18个月时分别为56.3%、56.3%、68.8%及81.3%。副反应主要有轻度胃肠道反应及轻度白细胞减低。结论环磷酰胺联合泼尼松治疗特发性膜性肾病安全、有效,但还需要大样本、前瞻性、对照研究进一步证实。

Objective To explore the clinical efficacy of combined prednisone and cyclophosphamide on idopathic membranous nephropathy.Methods Sixteen biopsy-proved idopathic membranous nephropathy patients were enrolled in this study.All patients were treated with prednisone combined with cyclophosphamide for 18 months：prednisone 0.5 mg·kg-1·d-1 for 3 months followed by gradually decreased dose till 15 mg/d;cyclophosphamide 0.6-0.8 g·m-2·month-1intraveneous infusion once a month for 6 months followed by same dose intraveneous infusion once every 3-month.The 24-hour urine protein excretion,plasma albumin and creatinine were observed in pre-and post-treatment.The overall remission and partly remission rate,effective and effectual rate were assessed in different treatment time-point post.Results At 3,6,12 and 18 months of treatment,the 24-hour urine protein excretion was （5.2±2.1）,（3.6±1.8）,（2.7±1.5）and （1.4±1.1） g/24 h,respectively,and compared with pre-treatment 〔（6.5±3.2） g/24 h〕,all the values obviously decreased （all P〈0.05）,and had further decreased trend along with prolongation of treating time;at 3,6,12 and 18 months of treatment,the plasma albumin values were （33.0±1.2）,（35.0±0.6）,（36.0±0.3）,（35.0±0.7） g/L,respectively,and compared with pre-treatment〔（26.0±0.8）g/L〕,all the values obviously increased （all P〈0.05）.The creatinine value remained unchanged post treatment （P〉0.05）.The effective rates were 56.3%,56.3%,68.8% and 81.3%,respectively at 3,6,12 and 18 months of treatment.The adverse effects were light gastro-intestinal effect and light leukopenia. Conclusions The treatment of idopathic membranous nephropathy using combined prednisone and cyclophosphamide is safe and effective,but further affirmance would be needed by massive sample and prospective control study.