摘要
[目的]比较霉酚酸酯(mycophenolate mofetil ,MMF)与间断性环磷酰胺(cyclophosphamide ,CTX)静脉冲击疗法治疗狼疮肾炎(lupus nephritis ,LN)的近期及远期疗效、不良反应及安全性.[方法]CTX组:间断性环磷酰胺冲击疗法联合激素治疗31例LN患者.MMF组:MMF联合激素治疗31例LN患者.两组患者的病理类型、病情基本相似,但MMF组为皮质激素联合CTX治疗无效者.[结果]CTX组、MMF组治疗LN均能降低蛋白尿,改善肾功能,提高血浆白蛋白,两组间差异无显著性意义.MMF组患者的平均疗程较CTX组明显延长,而疗效却基本相同.不良反应:MMF组未发现肝功能受累及白细胞减少者,感染率为16.1%,带状疱疹3.2%,胃肠道症状25.8%.CTX组感染率为29.0%,肝功能受损为25.8%,白细胞减少12.9%,胃肠道症状6.5%.其中胃肠道症状及肝功能异常的两组比较有统计学差异(P〈0.05).[结论]CTX,MMF都能有效地控制LN,两者无显著性差异.对激素联合CTX无效、病程长及病情迁延的LN患者,经MMF治疗后可达到与CTX组同样的效果,而且副作用少,显示MMF具有一定的优越性.
[Objective] To compare the short term and long term efficacy, adverse reactions and safety of mycophenolate mefetil(MMF) vs. intermittent intravenous pulse therapy with eyclophosphamide(CTX) for the treatment of lupus nephritis(LN). [Methods]CTX group(n= 31) was given intravenous CTX pulse therapy and prednisone. MMF group(n=31) was given MMF and prednisone. The patients in two groups had the similar pathology type and condition. Patients in MMF group were refractory to CTX therapy. [Resultsl Both CTX and MMF for the treatment of LN reduced proteinuria, improved renal function and increased plasma albumin, but there was no significant difference between the two group. The mean course of treatment of MMF group was significantly longer than that of CTX group, but the outcome of two groups was similar. Liver toxicity and leukopenia were not observed, while infections ( 16. 1 % ), herpes zoster (3.2% ) and gastrointestinal symptom(25.8% ) were found during MMF treatment. In CTX group, liver toxicity(25.8 %), infections(29. 0 % ), leukopenia( 12.9 % ) and gastrointestinal symptom(6.5 % ) were observed. There was significant difference in gastrointestinal symptom and liver toxicity between two groups( P 〈0.05). [Conclusion] Both CTX and MMF for the treatment of LN are effective, but there is no significant difference between them. MMF is predominant for the treatment of LN patients who are refractory to CTX combined with prednisone and have a long course of disease and protracted condition, and it has the same effect as CTX.
出处
《医学临床研究》
CAS
2011年第3期447-450,共4页
Journal of Clinical Research