霉酚酸酯治疗难治性肾病综合征的临床研究

The Clink Effect and Mechanism of Mycophenolate Mofetil in Refractory Nephrotic Syndrome

目的：观察霉酚酸酯（ＭＭＦ）治疗难治性肾病综合征的临床疗效及安全性。方法：选择对传统免疫抑制剂治疗无效或反复复发的原发性肾病综合征７例，治疗前后进行肾活检。结果：经ＭＭＦ治疗后，３／４例肾功能恢复正常，副作用仅见胃肠道反应２例（１５．４％）。肾小球ＩＣＡＭ－１和ＶＣＡＭ－１表达均较治疗前减少（Ｐ＜０．０１）。结论：ＭＭＦ对传统免疫抑制剂治疗无效的难治性肾病综合征（ＮＳ）疗效好，副作用小。ＭＭＦ抑制肾小球粘附分子表达，可能是对激素治疗无效的难治性肾病综合征产生良好疗效的机制之一。

Objective; To investigate the clinical efficacy and mechanism of mycophenolate mofetil (MMF) in refractory nephrotic syndrome. Methods: Seven patients with primary nephrotic syndrome, who had been treated with traditional immunosuppresants without improvement or with repeated relapses. All patients received renal biopsy before and after MMF treatment. Results: After the treatment mainly with MMF, the 24 hours urine proteins dropped from 4.78±1.24g to 1.17± 0.83 g, serum albumin increased from 26.7 ±4.9 g/L to 37.3 ± 5.8 g/L, hemourine of four out of seven patients disappeared, kidney function of three out of four patients recovered. The glomerular expression of ICAM-1 (P<0.01) and VCAM-1 (P<0.01) decreased significantly after treatment. Conclusion: MMF is effective and safe for refractory nephrotic syndrome, by a mechanism in which inhibition of glometular adhesion molecule expression might be involved.