霉酚酸酯治疗难治性肾病综合征和狼疮性肾炎的临床研究

Efficacy and safety of mycophenolate mofetil in treatment of refractory nephritic syndrome and lupus nephritis

目的 观察新型免疫抑制剂霉酚酸酯 (MMF)治疗难治性肾病综合征 (NS)和狼疮性肾炎 (LN)的疗效和安全性。方法 11例NS和 5例LN患者 ,对传统免疫抑制剂治疗无效或复发 ,改用MMF联合小剂量糖皮质激素治疗 ,每个月测定 2 4h尿蛋白、血清白蛋白、血常规、肝、肾功能 ,LN患者加测血清抗核抗体 (ANA)、抗双链DNA抗体 (A dsDNA)、补体C3。结果 NS组 ,2 4h尿蛋白定量从治疗前的 (5 .60± 0 5 )g d下降到 (2 3 7± 0 7)g d ,(P <0 0 1) ,血清白蛋白从治疗前的 (2 1 7± 1 3 )g L升高到 (3 5 3± 1 7)g L ,(P <0 0 0 1) ;LN组 4例ANA、A dsDNA转阴、补体C3上升到正常水平 ,其中 2例尿蛋白和血清白蛋白恢复正常 ,另 2例尿蛋白和血清白蛋白未完全恢复。两组各 2例重复肾活检 ,NS组 2例中 1例免疫球蛋白和免疫复合物沉积减少 ,1例FSGS者硬化肾小球增多 ;LN组 2例肾小球活动性病变显著减轻。结论 MMF对于难治性NS和LN ,经激素和环磷酰胺治疗无效者 ,约 70 %～ 80 %有较好疗效 ,且不良反应少。

Objective To investigate the efficacy and safety of mycophenolate mofetil(MMF), a novel immunosuppressive agent, in the treatment of refractory nephrotic syndrome(NS) and lupus nephritis(LN) Methods A total of 11 patients with NS and 5 patients with LN confirmed by renal biopsy and clinical information, and recurrent or refractory to glucocorticosteroid (Prednisone and/or Methylprednisolone) and cyclophosphamide (CTX), were treated with MMF in an initial dosage of 1 5 g/d followed by a deceased dosage of 1 0 g/d for 3 to 12 months (mean 7 2±2 7 months) Clinical and renal pathological changes were assessed monthly Results In the NS patients, their urinary protein excretion was decreased from (5 60±0 5) g/d to (2 37±0 7) g/d ( P <0 01), and serum albumin fell from (21 7±1 3) g/L to (35 3±1 7) g/L ( P <0 001) In 4 LN patients treated with MMF, the serum auto antibodies reduced significantly, while complement C 3 was increased to normal level, and negative conversion rate of ANA, A dsDNA were 80% within 6 months Urinary protein and serum albumin became normal in 2 LN patients but didn't in the other two For the 2 patients from every group undergoing biopsy, the immune complex and immune globulin reduced significantly in 1 patient with NS and glomerulus sclerosis were observed in another NS patient with FSGS; active lesions of 2 LN patients was significantly reduced No remarkable side effect was observed in this study Conclusion MMF can be used in NS and LN patients, especially for those refractory to other conventional agents with advantage of less severe side effects