吗替麦考酚酯治疗难治性狼疮性肾炎疗效及安全性观察

目的观察环磷酰胺(CTX)治疗无效的难治性狼疮性肾炎(LN)应用吗替麦考酚酯(MMF)的疗效及安全性。方法收集2009年1月～2011年8月门诊或住院的16～60岁、CTX治疗无效的LN患者。应用MMF1.0g2次/d,观察6个月。疗效评价为完全缓解,部分缓解和无效,达到完全缓解或部分缓解为有效。结果收集CTX治疗无效的LN患者10例。1例尿蛋白定量(24h)1.5～2.9g,9例患者尿蛋白定量(24h)>3g。应用MMF治疗过程中,尿蛋白定量(24h)水平显著下降,从基线(4.5±3.0)g降至6个月(0.9±1.0)g,差异有统计学意义;血清白蛋白水平逐渐上升趋势,从基线(30.7±5.4)g/L升至6个月(36.1±4.8)g/L,差异有统计学意义。在治疗第1个月末,7例无效,3例部分缓解;在治疗第2个月末,3例无效,7例部分缓解;在治疗第4个月末,1例无效,2例部分缓解,7例完全缓解。在治疗第6个月末,1例无效,1例部分缓解,8例完全缓,有效率90%。10例患者中1例出现泌尿系结核,1例出现腹泻,观察期间无其他不良反应。结论 MMF联合激素治疗对CTX无效的LN有效,是一种快速有效的缓解LN的治疗方法 ,同时药物安全性好。

Objective To observe the safety and efficacy of the treatment for lupus nephritis by mycophenolate mofetil.Methods Patients of lupus nephritis between the age of 16-60 years which visited from Jan. 2008 to Aug. 2011. The patients were given MMF lg twice a day for 24 weeks. The therapeutic efficiency were divided into complete remission,partial remission and inefficacy were evaluated .Results 10 patients were collected.The urine protien per 24 hour ,one patient had arrived 1.5-2.9g,the left 9 patients 〉3g.The urine protien per 24 hour had decreased from the baseline （4.5±3.0）g to （0.9±1.0）g with the treatment of MMF for 6 months and had statistical significance.Serum albumin had increased from the baseline （30.7±5.4）g/L to （36.1±4.8）g/L.7 patients were partial remission and 3 were inefficacy at the end of the first month.7 cases were partial remission and 3 cases were inefficacy at the end of the second month.7 patients were complete remission ,2 cases were partial remission and 1 case was inefficacy at the end of the forth month.8 patients were complete remission, 1 case was partial remission and 1 case was inefficacy at the end of the sixth month,the effective rate had reached 90%.Among the 10 patients,one patients had intestinal tuberculosis and one had diarrhoea during the MMF treatment,there were not other adverse reactions be observed.Conclusion Combination therapy of MMF and glucocorticosteroid is effective to the patient that invalid to cyclophosphamide treatment,and is an effective, rapid and safe method to the remission of lupus nephritis.