新型免疫抑制剂霉酚酸酯治疗狼疮性肾炎

Evaluation of the efficacy of mycophenolate mofetil treatment in lupus nephritis

目的 观察新型免疫抑制剂霉酚酸酯 (MMF)治疗狼疮性肾炎的临床疗效和安全性。方法 经肾活检证实的 2 0例狼疮性肾炎 ,给予糖皮质激素联合MMF治疗。MMF初始剂量 1.0～ 1.5 g/d ,治疗时间 3～ 2 1个月 ,平均 (10 .9± 6 .2 )个月。结果 MMF治疗后 2 4h尿蛋白定量从治疗前的平均 5 .5 5g下降至 1.5 4g ;血清白蛋白治疗前平均 2 6 .87g升至 39g ;6 /8例肾功能不全患者 3个月内Scr恢复正常 ;血清自身抗体产生明显减少 ,补体上升 ,其中ANA转阴率 3个月达 6 3% ,6个月达 81% ;抗ds DNA由治疗前 2 3.77IU/ml下降至 9.19IU/ml;2例重复活检 ,肾小球活动性病变明显减轻。MMF治疗的不良反应较少 ,偶有白细胞减少、感染、带状疱疹等。结论 MMF对于各型狼疮性肾炎 ,尤其是Ⅳ型重症狼疮 ,经传统治疗无效者均有较好疗效 ,且长期应用不良反应少。

Objective To investigate the efficacy and safety of mycophenolate mofetil (MMF) treatment of lupus nephritis. Method 20 patients with lupus nephritis confirmed by renal biopsy were treated by combined prednisone and MMF therapy. Results The initial dosage of MMF was 1.0～1.5 g/d. The treatment duration was 10.9±6.2 months (range 3～21 months). After treatment, 24 hours urinary protein excretion decreased from 5.55 g to 1.54 g, serum albumin increased from 26.87 g/L to 39 g/L.6 of 8 patients with renal insufficiency. The serum creatinine fell to normal. Serum autoimmune antibodies reduced significantly, while complements were increased. Negative conversion rate of ANA was 63% within 3 months and 81% in 6 months,the anti ds DNA antibody reduced from 23.77IU/ml to 9.19IU/ml. Two patients underwent a second biopsy , the glomerula activity index improved significantly. The side effects of MMF were uncommon, leukopenia, infection and herpes zoster were seldom observed. Conclusion MMF can be used in lupus nephritis, especially in type Ⅳ, and in patients refractory to other convensional treatment regimes. There is no severe adverse effect with long term treatment. (Shanghai Med J, 2000,24∶81 84)