霉酚酸酯与环磷酰胺冲击疗法在狼疮性肾炎诱导治疗中的对照研究

Comparison between mycophenolate mofetil and cyclophosphamide pulse therapy in induction treatment of active lupus nephritis

目的 :比较新型免疫抑制剂霉酚酸酯 (MMF)与间断性环磷酰胺 (CTX)静脉冲击疗法对活动性狼疮肾炎 (L N)的诱导治疗效果及不良反应发生情况。方法 :2 7例活动性 L N患者分两组 ,12例予 MMF 1.0～ 1.5 g/ d为口服治疗 (MMF组 ) ,15例行间断性 CTX冲击治疗 (0 .75～ 1.0 g/ m2 ,CTX组 ) ,两组均联合服用泼尼松。两组治疗前一般情况相似 ,治疗期 6个月 ,随访相关指标并监测伴随的不良反应 ,部分患者作重复肾活检。结果 :两组患者治疗后全身狼疮活动均明显受到控制。 MMF组在尿蛋白下降、贫血改善、肾功能改善及抑制自身抗体程度方面均比 CTX组更为明显。 MMF组中 9例重复肾活检示肾脏病理均有明显改善 ,CTX组中有 2例重复肾活检示肾脏病理改善不佳。MMF组不良反应发生率明显低于 CTX组。结论 :MMF联合激素在 L N诱导治疗中比 CTX冲击联合激素疗效更为突出 ,且伴随的不良反应较少。

Objective:To compare the efficacy of mycophenolate mofetil (MMF) and cyclophosphamide (CTX) pulse therapy in induction treatment of active lupus nephritis (LN). Methods:Twenty seven LN patients were included. Twelve patients were given MMF at a dose of 1.0 1.5 g/d orally(MMF group). The other 15 patients matched with age, sex and severity of renal damage were given CTX (0.75 1.0 g/m 2 body surface area) monthly for 6 months(CTX group).Both groups were supplemented with oral prednisone. The renal biopsy, blood and urinary routine, hepatic and renal function, 24 h urinary protein excretion, creatinine clearance(Ccr), anti dsDNA antibody titer, antinuclear antibody, serum complement C 3, immunoglobulin G and associated adverse effect were observed before and after treatment in both groups. Results:The SLE DAI, proteinuria, hematuria, anti dsDNA antibody titer and lower serum complement C 3 level were significantly improved in both groups after treatment ( P <0.05). Urinary protein excretion and anti dsDNA antibody titer in MMF group were lower than that of CTX group after treatment( P <0.05). Ccr and anemia were improved obviously in MMF group ( P <0.05), but changed slightly in CTX group( P >0.05).Nine patients in MMF group and 2 in CTX group had repeat renal biopsy. The active index and renal immune complex deposition decreased dramatically after given MMF, but the chronic index had no significant difference after treatment.There was no obvious improvement in CTX group.The incidence of complications was slighter in MMF group. Conclusion:MMF is more effective than CTX pulse therapy in the induction treatment of active LN, and with lower adverse effect.