地塞米松泼尼松序贯疗法治疗成人原发性肾病综合征临床观察

Clinical Observation of Sequential Therapy with Dexamethasone an d Prednisone in Treating Adult Primary Nephrotic Syndrome

目的探讨地塞米松、泼尼松序贯疗法治疗成人原发性肾病综合征的疗效。方法 64例原发性肾病综合征患者随机分成地塞米松、泼尼松序贯疗法组(观察组)22例、口服泼尼松标准疗法组(对照组A)21例和甲泼尼龙、泼尼松序贯疗法组(对照组B)21例,观察水肿消退时间和尿蛋白转阴时间、达到缓解所需时间、疗效及不良反应发生率。结果观察组水肿消退时间和尿蛋白转阴时间比对照组A短,差异有统计学意义(P<0.05),但和对照组B比较差异无统计学意义(P>0.05)。3组治疗效果比较差异无统计学意义(P>0.05),但达到缓解所需时间观察组比对照组A短,差异有统计学意义(P<0.05),但和对照组B比较差异无统计学意义(P>0.05);3组不同治疗方案不良反应发生率比较差异无统计学意义(P>0.05)。结论地塞米松、泼尼松序贯疗法较标准泼尼松疗法能快速诱导原发性肾病综合征缓解,缩短水肿消退时间和尿蛋白的转阴时间,且较甲泼尼龙、泼尼松序贯疗法水钠潴留作用小,价格便宜,在基层医院有一定推广应用价值。

Objective To explore the effect of sequential therapy using dexamethasone and prednisone in treating adult primary nephrotic syndrome. Methods 64 patients suffered with primary nephrotic syndrome were randomly divided into 3 groups, which were treated respectively by sequential therapy with dexamethasone and prednisone （observational group, 22 cases）, standard treatment with prednisone administrated orally （control group A, 21 cases）, and sequential therapy with methylprednisolone and prednisone （control group B, 21 cases）. Regression time of edema, disappearing time of urine protein, relieving time of the symptoms, therapeutic effect, as well as incidence of adverse effects were recorded and compared between the different groups. Results Regression time of edema and disappearing time of urine protein of observational group were significantly less than those of control group A （P〈0.05）, but no statistical differences were found between the observational group and control group B （P〈0. 05）. Therapeutic effects between the 3 groups exhibited no statistical differences （P〉0.05）. As for relieving time of the symptoms, it was statistically shorter for observational group as compared with control group A （P〈0.05）, while no difference was found between observational group and control group B （P〉0.05）. And no differences in incidence of adverse effects were found among the three groups. Conclusion As eompared with standard prednisone treatment in treating primary nephrotie syndrome, sequential therapy with dexamethasone and prednisone can induce relieving the symptoms promptly, shortening regression time of edema as well as disappearing time of urine protein. At the same time, such a treatment method exhibited less water sodium retention effects and is much cheaper than sequential therapy with methylprednisolone and prednisone, thus is worthy of spreading its use in primary hospitals.