醋酸泼尼松不同方案治疗特发性膜性肾病的效果对照评价

Effects of different options of prednisone acetate for patients with idiopathic membranous nephropathy

目的观察并探讨醋酸泼尼松(Pre)不同方案治疗特发性膜性肾病(Idiopathic membranous nephropathy,IMN)的有效性和安全性。方法选择自2009年2月—2014年2月在义乌市中心医院治疗的IMN患者48例,按照随机数字法将患者分为2组,A组和B组各24例,A组给予Pre联合来氟米特(Leflunomide,LEF)治疗,而B组给予Pre联合环磷酰胺(Cyclophosphamide,CTX)治疗。治疗后统计2组患者的症状缓解情况,治疗前后血肌酐(Serum creatinine,Sr)、24 h尿蛋白定量(24 h Upro)及血浆白蛋白(ALB),以及并发症发生情况。结果 A组缓解率为79.1%(19/24),B组为70.8%(17/24),2组相比,差异不具有统计学意义(P>0.05);2组治疗前Sr、24 h Upro和ALB相比,差异不具有统计学意义(P>0.05);治疗后,2组24 h Upro明显下降,血浆白蛋白明显增加(P<0.05),且2组相比,差异不具有统计学意义(P>0.05);A组并发症率为8.3%(2/24),B组为37.5%(9/24),2组相比,差异具有统计学意义(P<0.05)。结论 LEF联合Pre治疗能明显改善IMN患者的临床症状,疗效显著,且比CTX治疗具有更低的不良反应率,是安全有效的疗法。

Objective To observe the clinical value and safety of different options of prednisone acetate（Pre） for patients with idiopathic membranous nephropathy（IMN）. Methods 48 patients with IMN in this hospital since February 2009 to February 2014 were selected, all patients were randomly divided into two groups,24 cases in A group and 24 cases in B group. The group A was treated by Pre combined with LEF, while group B by Pre combined with CTX. After the treatment, the remission of symptoms of both groups was documented. The levels of serum creatinine（Sr） ,24 h urinary protein excre- tion （24 h Upro） and albumin（ALB） were tested, and complications were observed. Results Remission rate was 79.1% （19/24） in A group ,while was 70.8% （17/24） in group B, the difference was not statistically significant （P 〉 0.05 ） ; the difference of Sr,24 h Upro and ALB before treatment between the two groups was not statistically significant （P 〉 0.05 ） ; after treatment, 24 h Upro decreased, ALB increased significantly in both groups （ P 〈 0.05 ） ; complication rate was 8.3% （2/24） in A group, while was 37.5% （9/24） in group B, the difference was statistically significant （P 〈 0.05）. Conclusion Pre combined LEF therapy can significantly improve the clinical symptoms of IMN patients, has a significant effect,and a lower rates of adverse reactions when compare with CTX treatment, thus is a safe and effective therapy.