雷公藤多甙与环磷酰胺分别联合泼尼松治疗特发性膜性肾病疗效比较

Efficacy comparison of Tripterygium Wilfordii Polyglycoside and Cyclophosphamide combined with prednisone treatment on idiopathic membranous nephropathy

【目的】观察雷公藤多甙(tripterygium wilfordii,TW)与环磷酰胺(cyclophosphamide,CTX)分别联合泼尼松(prednisone,PED)治疗特发性膜性肾病(idiopathic membranous nephropathy,IMN)的疗效、复发率等差异。【方法】对随访的经TW+PED治疗组[分3次口服TW 2 mg.(kg.d)-1,缓解后减量维持,6个月无效者停药,同时口服PED 0.5～1 mg.(kg.d)-1,8周后逐渐减量]和经CTX+PED治疗组[静脉滴注CTX 0.5～1.0 g.(m2.m)-1,1次/月,共6个月,此后每3个月1次,累计剂量8～10 g,同时口服PED0.5～1 mg.(kg.d)-1,8周后逐渐减量]定期检测尿蛋白定量、血清白蛋白、肝肾功能等指标,对患者治疗期间的疾病缓解率、复发率等进行观察。【结果】两组尿蛋白定量及血浆白蛋白水平较治疗前明显好转(P<0.05),治疗前后肝肾功能未见明显变化,TW+PED治疗组患者最大缓解率出现在约第6个月;CTX+PED治疗组患者最大缓解率出现在约第12个月,两组总缓解率无统计学差异(P>0.05)。TW+PED组患者复发出现在约第12个月;CTX+PED治疗组患者复发出现在约第18个月,CTX+PED治疗组复发率明显低于TW+PED治疗组(P<0.05)。【结论】两种治疗方法对IMN均有一定的疗效。TW+PED方法和CTX+PED方法相比较,前者患者的病情缓解发生早于后者,在总缓解率方面两者之间不存在明显的差异,但前者短期的复发率要高于后者。对于两种治疗方法的远期效果及患者肾功能的进展,仍需进一步的长期随访观察。

【Objective】 To evaluate the efficacy and recurrent rate of Tripterygium Wilfordii Polyglycoside（TW）and Cyclophosphamide（CTX）in combination with Prednisone（PED）in the treatment on idiopathic membranous nephropathy（IMN）.【Method】 Patients diagnosed as IMN by renal biopsy were treated TW [2 mg·（kg·d）-1,tid,if remitted,the dose was decreased for maintenance treatment,if no efficiency was observed after 6 months,TW should not be administrated.Prednisone 0.5~1 mg·（kg·d）-1 was administered concomitantly] and CTX 0.5~1.0 g·（m2·m）-1,administered via intravenous route every month for 6 months,subsequently administered every three months,8~10 g in total.Prednisone [0.5~1 mg·（kg·d）-1 was administered concomitantly].Urine protein quantification,serum albumin,hepatatic and renal function were measured regularly.The remission rate and recurrent rate were evaluated during treatment.【Results】 Urine protein quantification and serum albumin after treatment were improved as compared those before treatment（P 〈 0.05）,no significant difference in hapatatic and renal function was found between two groups before and after treatment.The peak remission rate in TW group was observed in 3~6 months after treatment,which was observed in CTX group in 12 months after treatment,there was no statistical difference between two groups（P 〉 0.05）.The trough recurrence rate in TW group was observed around 12 months after treatment,which was observed in CTX group in 18 months after treatment.The recurrence rate in CTX group was signific-two groups,but the short term remissionrate in TW group is higher than that in CTX group.The long term efficiency and effect on renal function progress of both dugs to IMN patients were needed to further follow up.