泼尼松联合环磷酰胺治疗肾病综合征并肾功能不全41例疗效及安全性评价

Efficacy and Safety Evaluation of Prednisone Combined with Cyclophosphamide in Treating 41 Cases of Nephrotic Syndrome Complicating Renal Insufficiency

目的评价糖皮质激素联合环磷酰胺对肾病综合征并肾功能不全的临床疗效及安全性。方法选取2012年1月至2014年1月医院收治的肾病综合征患者82例,采用随机数字法随机分为两组,各41例。观察组采用泼尼松联合环磷酰治疗,对照组单用糖皮质激素治疗,检测治疗前后血清总胆固醇(TC)、甘油三酯(TG)、白蛋白(Alb)、24小时尿蛋白定量(24 h UPE)、血肌酐(Scr)、血尿素氮(BUN)水平,观察不良反应发生情况。结果观察组治疗后TC,TG,24 h UPE水平均明显低于对照组(P<0.05),Alb水平明显高于对照组(P<0.05)。观察组治疗后Scr及BUN水平均高于对照组,但差异无统计学意义(P>0.05)。观察组药物对肝脏及血液系统的损害较明显,19.51%的患者出现肝功能异常,14.63%的患者出现白细胞减少,发生率明显高于对照组(P<0.05)。结论糖皮质激素联合环磷酰胺对于减轻肾病综合征患者的尿蛋白、提高血清白蛋白水平的作用优于单用糖皮质激素治疗,但对于改善患者肾功能没有意义。环磷酰胺具有较明显的肝肾毒性,使用过程中应严密观察不良反应。

Objective To evaluate the clinical efficacy and safety of glucocorticoid combined with cyclophosphamide in treating the pa-tients with nephrotic syndrome complicating renal insufficiency. Methods 82 patients with nephrotic syndrome treated in our hospital from January 2012 to January 2014 were selected and randomly divided into the two groups by adopting the random numer table method, 41 cases in each group. The observation group received prednisone combined with cyclophosphamide therapy, while the control group was treated with the glucocorticoid therapy alone. The levels of serum total cholesterol （ TC ） , triglyceride （ TG ） , albumin （ Alb ） , 24 h urinary protein excretion （ 24 h UPE ） , serum creatinine （ Scr ） , blood urea nitrogen （ BUN ） before and after treatment were detected and the occurrence situation of adverse reactions were observed. Results The serum levels of TC, TG, 24 h UPE after treatment in the obser-vation group was significantly lower than those in the control group, the differences were statistically significant （ P〈0. 05 ） . The serum Scr and BUN levels after treatment in the observation group was significantly higher than those in the control group, but the difference had no statistical significance （ P〉0. 05 ） . The damage of drugs on liver and blood system in the observation group was more obvious, 19. 51% of patients appeared the liver function abnormality, 14. 63% of patients appeared neutropenia, the occurrence rate in the obser-vation group was significantly higher than that in the control group （ P〈0. 05 ） . Conclusion Glucocorticoids combined with cyclophos-phamide is better than simple glucocorticoids therapy in alleviating urinary protein and increasing serum albumin level, but there is no sense in improving the renal function. Cyclophosphamide has obvious hepatorenal toxicity, more attention should be paid to observing the adverse events of the patients.