霉酚酸酯与环磷酰胺治疗难治性狼疮性肾炎的疗效比较

Comparison of curative effect of mycophenolate mofetil and cyclophos-phamide for the treatment of refractory lupus nephritis

目的比较霉酚酸酯(MMF)与环磷酰胺(CTX)联合激素治疗难治性狼疮性肾炎(LN)的疗效和安全性。方法将79例难治性狼疮性肾炎患者随机分为两组,治疗组39例激素加霉酚酸酯,对照组40例激素加环磷酰胺,疗程2年,比较两组治疗前后24 h尿蛋白、血清ANA、血浆白蛋白、补体、缓解率的变化以及不良反应发生率。结果①临床缓解率MMF组高于CTX组(P<0.05);②化验指标两组患者在经过相应的治疗之后,患者的尿蛋白数量比治疗之前有所减少,而血浆白蛋白及补体的数量处于上升阶段,ANA阳性率差异(MMF组χ2=25.647,CTX组χ2=14.587)均有统计学意义(P<0.01);且MMF组与CTX组治疗后比较差别有统计学意义(P<0.05);③不良反应MMF组药物不良反应低于CTX组(P<0.01)。结论 MMF联合强的松治疗难治性LN疗效显著,不良反应少,明显优于CTX联合强的松的疗效。

Objective To compare the clinical efficacy and safety of mycophenolate mofetil （MMF）and cyclophos phamide （CTX） combined prednisone therapy refractory lupus nephritis （LN）. Methods Seventy-nine patients with refractory lupus nephritis were randomly divided into two groups. Thirty-nine cases were treated with prednisone plus mycophenolate mofetil in treatment group. Forty cases were treated with prednisone plus cyclophosphamide in control group.Ttreatment course was two years, compared two groups before and after treatment, 24 h urinary protein, serum ANA, the change of plasma albumin, complement, remission rate and incidence of adverse reactions. Results （ 1 ）The clinical remission rate： The clinical remission rate in MMF group was higher than that in CTX group（P〈0.05） ; （2） Laboratory indicators： Two groups of patients after corresponding treatment, patients urine protein quantity decreased than before treatment,and plasma albumin and the number of complement in the rising stage, the ANA positive rate difference （MMF group X2=-25.647 ,CTX group XZ=-14.587） had statistical significance （P〈0.01）; And MMF group compared to CTX group after treatment was statistically significant difference （P〈0.05） ; （3）The adverse reactions： Drug adverse reaction in MMF group was lower than that in CTX group （P〈0.01）. Conclusion Curative effect of MMF combined with prednisone treating refractory LN is more distinct,less adverse reaction,better than CTX combined with prednisone.