大剂量长春新碱冲击治疗成人难治性肾病综合征疗效观察

High-dose vincristine pulse therapy for refractory nephrotic syndrome in adults

目的观察钱桐荪教授设计的大剂量长春新碱（VCR）冲击疗法在成人难治性原发性肾病综合征中的疗效和不良反应。方法选择成人难治性原发性肾病综合征患者13例，采用VCR4mg加入0．9％氯化钠注射液或5％葡萄糖注射液100ml中静脉注射，每个月1次，共治疗6个月。结果13例患者中，完全缓解及基本缓解11例，部分缓解2例；总有效率为100％。起效时间为0．5～1个月。治疗前、后肝功能均在正常范围，治疗前1例血肌酐155umol／L，治疗后降至正常。最多见不良反应者为10例有不同程度的肢体末端麻木和轻度脱发；消化道症状明显6例，其中较严重1例。首次治疗不良反应较重，然后逐渐减轻。结论VCR冲击治疗成人难治性肾病综合征疗效好，患者均能耐受不良反应。值得进一步研究和探讨。

Objective To observe the efficacy and adverse reactions of high-dose of vincristine therapy regime, designed by Professor Tongsun QIAN, in adults with refractory primary nephrotic syndrome. Methods Vincristine （4 mg） was added into 100 mL normal saline or 5% glucose intravenous infusion, once a month, for 6 months. Results Among 13 patients （renal biopsy： 5 cases of MN, 1 case of amloidosis, 2 cases of IgAN） in this trial, 11 cases got complete or almost remission, and 2 cases got partial remission; total effective rate was 100%. The average onset time of improvement was 2-4 weeks. Liver function before and after treatment was within the normal range. In one case, serum creatinine before treatment was 155umol/L and normalized after treatment. The most common adverse reactions were different degrees of extremity numbness and mild hair loss in 10 cases; GI symptoms in 6 cases. The adverse reactions gradually reduced after first dose of the treatment. Conclusions High-dose of vincristine pulse treatment for refractory nephrotic syndrome in adults is very satisfactory with tolerable adverse reactions profile for adult patients and low cost. Authors believed it is worthy of further large clinic trial.