环孢素联合泼尼松治疗膜性肾病的疗效观察

The analysis of short and long term clinical efficacy of cyclosporin and hormone in the treatment of patients with idiopathic membranous nephropathy

目的：观察环孢素联合泼尼松治疗膜性肾病的临床疗效及安全性，为临床治疗提供新选择。方法将符合入组标准的84例特发性膜性肾病患者按数字表法随机分为观察组和对照组，每组各42例；对照组给予环磷酰胺（CTX）联合泼尼松治疗；观察组给予环孢素联合泼尼松治疗，两组患者均治疗12个月，治疗前、治疗3个月、6个月、9个月、12个月后比较两组患者24 h 尿蛋白、血清白蛋白、肌酐、丙氨酸氨基转移酶；所有患者均随访2年，评价两组近期临床疗效并对比疗效差异性，统计随访2年累计复发率，记录不良反应发生情况。结果对照组和观察组治疗后3个月、6个月、9个月、12个月的24 h 尿蛋白分别为（5．6±2．6）g 和（4．0±2．1）g，（4．0±2．2）g 和（3．2±1．6）g，（3．8±1．4）g 和（3．0±1．5）g，（3．1±1．6）g 和（3．0±1.4）g，较治疗前明显降低（F ＝4．513和6．443）（均 P ＜0．05）；血清白蛋白分别为（24．5±7．8）g／L 和（25．8±3．2）g／L，（26．2±6．4）g／L 和（31．1±9．4）g／L，（28．6±8．8）g／L 和（33．2±10．0）g／L，（33．6±9．4）g／L 和（35．8±9.8）g／L，均较治疗前明显升高（F ＝5．319和7．221，均 P ＜0．05）；观察组治疗后3个月、6个月、9个月24 h 尿蛋白明显低于对照组（t ＝3．737、3．334、3．915，均 P ＜0．05）；血清白蛋白明显高于对照组（t ＝3.356、3．832、3．774，均 P ＜0．05）。观察组和对照组治疗后3个月、6个月、9个月的临床疗效分别为48．24％和26．19％，85．71％和69．05％，88．10％和73．81％（χ2＝6．652、5．977、7．239，均 P ＜0．05）。观察组和对照组治疗后1年、2年的累积复发率差异无统计学意义（均 P ＞0．05）；观察组和对照组的不良反应发生率分别为30．95％和11．91％（χ2＝4.592，P ＜0．05）。结论环孢素能够有效降低膜性肾病患者蛋白尿，提高血清白蛋白，且起效速度快，近期疗效更高，虽然不良反应有所增加，但易于监测和控制，对于 CTX 治疗无效或复发的患者可考虑使用。

Objective To observe the clinical efficacy of cyclosporin and hormone in the treatment of patients with idiopathic membranous nephropathy,to provide a new choice for the clinical treatment.Methods 84 patients with idiopathic membranous nephropathy met the inclusion criteria were randomly divided into the observation group and control group,with 42 cases of each group.The control group was treated with cyclophosphamide （CTX）and prednisone,while the observation group was given cyclosporin and prednisone,both group had been treated for 12 months.Blood were exsanguinated for detecting 24h urine protein,serum albumin,creatinine,alanine aminotransferase before treatment and after treatment for 3 months,6 months,9 months and 12 months.All patients had been follow -up for 2 years for making a statistics of 2 -year cumulative recurrence rate,the short and long term clinical efficacy were compared and the adverse reactions were recorded.Results The 24h urine protein of the control group and observation group after 3 months,6 months,9 months and 12 months treatment were （5.6 ±2.6）g vs.（4.0 ±2.1）g, （4.0 ±2.2）g vs.（3.2 ±1.6）g,（3.8 ±1.4）g vs.（3.0 ±1.5）g,（3.1 ±1.6）g vs.（3.0 ±1.4）g,the observation group were significantly lower than before treatment （F =4.513 vs.6.443,all P 〈0.05）.The serum albumin of the control group and observation group were （24.5 ±7.8）g/L vs.（25.8 ±3.2）g/L,（26.2 ±6.4）g/L vs.（31.1 ± 9.4）g/L,（28.6 ±8.8）g/L vs.（33.2 ±10.0）g/L,（33.6 ±9.4）g/L vs.（35.8 ±9.8）g/L,both group were signifi-cantly higher than before treatment （F =5.319 vs.7.221,all P 〈0.05）.The 24h urine protein of the observation group were significantly lower than the control group,（t =3.737,3.334,3.915,all P 〈0.05）.The serum albumin were significantly higher than the control group,（t =3.356,3.832,3.774,P 〈0.05.2）.The clinical efficacy of the observation group and the control group after treatment for 3 months,6 months,9 months were 48.24% vs.26.19%,85.71% vs.69.05%,88.10% vs.73.81% （χ2 =6.652,5.977,7.239,all P 〈0.05.3）,the cumulative recurrence rate after one year and two year had no difference between the two group,all P 〉0.05.The adverse reaction rates of the observation group and the control group were 30.95% vs.11.91%,χ2 =4.592,P 〈0.05.Conclusion Cyclos-porin can effectively reduce proteinuria and increased serum albumin faster,it has better short and long term clinical efficacy,the adverse reactions is easy to monitor and control although high,it can be considered for using because of invalid or relapse for CTX.