环磷酰胺冲击治疗狼疮肾炎的临床研究

Clinical study of CTX pulse treatment on lupus nephritis

目的通过临床对比研究，探讨应用环磷-酰胺冲击治疗（IV－CTX）狼疮肾炎（LN）的最佳方案。方法将92例LN患者随机分成3组：A组，IV－CTX每2周1次，每次（8～12）mg／kg，连用2天，B组，IV－CTX每月1次，每次（0．5～1．0）g／m2；C组，IV－CTX每3个月1次，每次（0．5～1．0）g／m2。3组均同时口服波尼松。结果A组起效时间显著比B组与C组快；病情缓解率A组也显著高于B组及C组（P＜0．01）；病情活动性积分下降至25％、50％和75％时，3组CTX累积量无显著差异（P＞0．05）；3组间不良反应及其发生率无显著统计学差异（P＞0．05）。结论IV－CTX治疗LN应根据狼疮活动程度选择。在急重症LN，应用A组2周1次方案有利于及时控制狼疮活动，提高疗效，保护肾功能；在LN病情基本控制后，改用B组每月1次方案可以巩固疗效；在LN病情完全控制后，应用C组3个月1次方案可以预防复发。

To investigate the best method of CTX pulse therapy(IV-CTX) on lupusnephritis (LN). Methods 92 cases of LN were divided into three groups randomly. Group A: Two-dayIV-CTX (8~12mg/kg. d) every two weeks; Group B: IV-CTX (O.5~1.0g/m2)once a month; GroupC: IV-CTX(0. 5~1. 0g/m2) every three months. Prednisone was a basical treatment in each group. Results The time taking effect in group A was shortest, and also had the most significant remission rate(P<0. 01). There was no significant difference of CTX accumulative quantity among three groupswhen disease activity score decreased to 25%,50% and 75%, and there was no significant difference among three groups in side effect either (P>0.05). Conclusion A reasonable IV-CTX should be chosenaccording to the disease activity.