环磷酰胺与环孢素A治疗难治性肾病的疗效观察

Difference in Efficacy of Cyclophosphamide and Cyclosporine A in Treatment of Refractory Nephritic Syndrome

目的观察对比环磷酰胺和环孢素A治疗难治性肾病综合征的疗效差异。方法将28例难治性肾病综合征患者随机分为A、B两组,在口服泼尼松0.5 mg/（kg·d）^-1治疗的基础上,A组静脉滴注环磷酰胺CTX 600-1 000 mg（或10-15 mg/kg）,每月1次,累积6.0-8.0 g;B组口服环孢素5.0 mg/（kg·d）^-1。进行1年的随访,在治疗前、治疗3、6、12个月,分别记录尿常规、24 h尿蛋白定量、肝功能（AST、ALT、Alb）、肾功能（CRE、UA、GLU）等指标的变化,并记录不良反应。结果两组患者各项指标均较治疗前好转。从治疗3个月开始,部分患者的尿蛋白定量及血浆白蛋白水平开始有所恢复,前后结果差异有统计学意义（P〈0.05）。结论环磷酰胺及环孢素A均可以有效的治疗难治性肾病综合征,治疗同期两者差异不明显,并且治疗过程中未出现严重的不良反应。

Objective To observe the difference in the efficacy of cyclophosphamide and cyclosporine A in the treatment of refractory nephrotic syndrome.Methods 28 cases of patients with refractory nephrotic syndrome were randomly divided into group A and group B.On the basic treatment with prednisone at the dose of 0.5 mg/（kg·d）^-1,cyclophosphamide was injected in group A at the dose of 600~1 000 mg（or 10~15 mg/kg） per month until the total dose of 6.0~8.0 g;cyclosporine A was given orally at the dose of 5.0 mg/（kg·d）^-1.In a one-year follow,routine urine test,24-hour urine quantitative protein,liver function（AST,ALT,ALb） and renal function（CRE,UA,GLU） were recorded respectively before treatment and 3,6 and 12 months after treatment.Side effects were also recorded.Results Each index of the two groups of patients was improved after treatment.In a part of patients,the levels of urine quantitative protein and serum albumin began to recover after 3 months of treatment,and the difference between the former and the later was of statistic significance（P〈0.05）.Conclusion Both cyclophosphamide and cyclosporine A were effective in treating refractory nephrotic syndrome.There was no significant difference when the 2 kinds of treatment had been carried out simultaneously,and no serious side effects had been found.