霉酚酸酯联合激素治疗成人狼疮性肾炎的疗效观察

Clinical Efficacy of Mycophenolate Mofetil Combined with Hormone Treatment on Adults with Lupus Nephritis

目的探讨霉酚酸酯(MMF)联合激素治疗成人狼疮性肾炎(LN)的临床疗效及其安全性。方法选取自2006年6月至2011年10月仙桃市第一人民医院收治的26例LN患者,给予MMF联合糖皮质激素进行规范治疗。糖皮质激素(20～40 mg/d),逐渐减量,MMF初始剂量1.5 g/d,3个月后减至维持剂量0.75～1.0 g/d继续治疗,治疗时间3～24个月。结果 MMF联合糖皮质激素治疗后24 h尿蛋白下降,血清白蛋白升高,血清自身抗体显著减少,补体C3、C4升高;26例患者重复活检,肾小球活动性病变显著减轻。MMF治疗的不良反应较少,偶有消化道反应、感染及带状疱疹发生等。结论 MMF对于成人各型LN,尤其是经传统治疗无效者,临床疗效显著、安全,且长期使用不良反应少。

Objective To explore the efficacy and safety of mycophenolate mofetil（MMF） combined with hormone treatment of adults with lupus nephritis.Methods From Jun.2006 to Oct.2010,26 patients with confirmed lupus nephritis were treated by glucocorticoid and MMF therapy in the First People＇s Hospital of Xiantao.Glucocorticoids（20-40 mg / d）,gradual reduction of the initial dose,MMF was 1.5 g / d,three months later reduced to a maintenance dose of 0.75 to 1.0 g / d to continue the treatment,treatment duration was 3 to 24 months.Results After treatment,24 hours urinary protein excretion decreased,serum albumin increased,serum autoimmune antibodies significantly reduced,complement C3 and C4 increased;26 cases of repeated biopsy,the glomerular active lesions were significantly reduced.The side effects of MMF were less,with occasional gastrointestinal reactions,infections and herpes zoster observed.Conclusion MMF can be used in lupus nephritis of adults,especially in patients refractory to other conventional treatment regimes,with distinct clinical curative effect,good safety and less side effects for the long-term application.