糖皮质激素联合沙利度胺治疗难治性膜性肾病临床效果

Glucocorticoid hormone combining thalidomide for refractory membranous nephropathy

目的观察和研究糖皮质激素联合沙利度胺治疗病理为难治性膜性肾病的临床效果。方法选择2014年10月至2016年5月本院收治的病理为难治性膜性肾病的患者32例，糖皮质激素＋沙利度胺50mg，2次，d，至尿蛋白转阴后再应用12周后减量为50mg，1次，d，维持半年停用。无效者最长服用24周停药。观察时间为24周。结果24h尿蛋白从治疗前（8．14±3．09）g降至（1．42±1．86）g（P〈0．01）；血浆白蛋白从治疗前（29．15±6．35）g／L升至（37．02±3．96）g，L（P〈0．01）。大部分病例开始显效时间在8～16周，完全缓解31．25％（10／32），部分缓解53．13％（17／32），总有效率为84．38％。结论沙利度胺联合糖皮质激素治疗膜性肾病效果明显，副作用轻微，为难治性膜性肾病的治疗提供了一种新途径，值得临床推广使用。

Objective To observe and study the clinical effect of glucocorticoid hormone combining thalidomide for refractory membranous nephropathy. Methods 32 patients with refractory membranous nephropathy treated at our hospital from October, 2014 to May, 2016 were selected and were treated with glucocorticoid hormone and thalidomide 50 mg 2 times/d until urine protein became negative and the treatment was continued for 12 weeks; then the patients were treated at the dosage of 50 mg, once per day for half year. The patients taking these drugs without effect were treated for 24 weeks. The observation time was 24 weeks. Results The 24 h urine protein decreased from （8.14~3.09） g before the treatment to （1.42＋1.86） g after the treatment （P 〈 0.01） and plasma albumin increased from （29.15α6.35） g/L to （37.02α3.96） g/L （P 〈 0.01）. The treatment took effect in most the patients in 8 - 16 weeks. The complete remission rate was 31.25% （10/32） and the partial remission rate 53.13% （17/32）; the total effective rate was 84.38%. Conclusions Glucocorticoid hormone combining thalidomide for refractory membranous nephropathy is obviously effective and has mild side effect, so it provides a new treatment method for refractory membranous nephropathy and is worth being clinically generalized.