环磷酰胺冲击联合激素治疗特发性膜性肾病的预后分析

Prognostic analysis of CTX combined with hormone therapy in idiopathic membranous nephropathy

目的探讨环磷酰胺(CTX)静脉冲击联合激素治疗特发性膜性肾病的疗效及患者预后的影响因素。方法我院门诊长期随访的经肾活检确诊的60例特发性膜性肾病患者,按随机数字表法分为两组各30例,均接受CTX冲击联合激素治疗方案,观察组单月予甲泼尼龙0.5 g静脉冲击,连续3日,后续予泼尼松0.5 mg/(kg·d)维持,4周后停药,双月予CTX冲击1次,剂量0.75 g/m2,且停用泼尼松。对照组首6个月每月予CTX冲击1次,剂量0.75 g/m2,此后每2个月1次,共9次,同时口服泼尼松,初始剂量0.75 mg/(kg·d),逐步降低至10 mg/d维持治疗。门诊观察12个月,统计患者临床疗效及预后,并分析影响患者预后的因素。结果两组尿蛋白定量、血清白蛋白、胆固醇、血白细胞、肌酐、谷丙转氨酶变化趋势一致,差异均无统计学意义(P>0.05);两组治疗12个月后疗效差异无统计学意义(P>0.05);观察组不良反应发生率明显低于对照组(P<0.05);高血肌酐、高血压、大量蛋白尿、肾小球硬化是影响患者预后的主要因素(P<0.05)。结论 CTX冲击联合激素治疗特发性膜性肾病多能达到可靠疗效,对早期不存在高血肌酐、高血压、大量蛋白尿、肾小球硬化特点的患者,应用该方案的价值可能更充分;对采用CTX冲击联合激素治疗的患者,应用甲泼尼龙、CTX交替冲击有助于在保证疗效的基础上减少不良反应。

Objective To investigate the effect of cyclophosphamide （CTX） combined with prednisone therapy on idiopathic membranous nephropathy, and to identify the factors influencing the prognosis. Methods Sixty patients with idiopathic membranous ne- phropathy diagnosed by renal biopsy and long-term followed-up were randomly divided into observation or control group, 30 in each group. The both groups received the regimen javascript ：void（0） ;of CTX plus hormones. The regimen of the observation group was that intravenous injection of 0. 5 g methylprednisolone for 3 consecutive days followed by oral predsine ,0. 4 mg/（ kg · d） for 27 days in one month, and then,intravenous injection of CTX 0. 75 g/m2 once without predsine in the next month. The treatments were lasted for 6 cy- cles. The regimen of the control group was that CTX 0.75 g/m2 was given once a month for the first 6 months followed by once every two months in the next 6 months as well as taking predsine orally,dosage decreased from 0. 75 mg/（ kg · d） to 10 mg/d for maintenance. After 12 months ,the efficacy was compared between the two groups. The clinical pathological characteristics and prognosis of patients were statistically analyzed to find out the risk factors affecting prognosis. Results Urine protein, serum albumin, cholesterol, creatinine, white blood cells, and ALT in patients in both groups had the same change trend, and no significant difference was found between the two groups （ P〉0. 05 ）. The efficacy of the 12 months treatment was not significantly different between the two groups （ P〉0. 05 ）. How- ever, adverse reactions in the observation group were significantly less than that in the control group （ P〈0.05 ）. High serum creatinine, hypertension, proteinuria, and glomerular sclerosis were the main factors affecting the prognosis, of the patients （P〈0. 05 ）. Conclusion CTX combined with prednisone therapy for idiopathic membranous nephropathy can achieve reliable curative effect, especially for pa- tients without high serum ereatinine, hypertension, proteinuria and glomerular sclerosis. CTX and methylprednisolone used interchangea- bly helps to reduce the adverse reactions on the basis of guaranteed efficacy.