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霉酚酸酯联合激素治疗血清抗PLA2R抗体阳性特发性膜性肾病 被引量:3

Study on mycophenolate mofetil combined with prednisone in the treatment of idiopathic membranous nephropathy with positive serum anti-phospholipase A2 receptor antibody
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摘要 目的 评估霉酚酸酯联合激素治疗血清抗磷脂酶A2受体(PLA2R)抗体阳性特发性膜性肾病患者的疗效. 方法 选择24例2012年6月至2016年6月在广州市第一人民医院肾活检证实为特发性膜性肾病且血清抗PLA2R抗体阳性患者进行一项开放前瞻性研究.这24例患者被分为两组:口服霉酚酸酯联合泼尼松12个月的霉酚酸酯治疗组(MMF组)和每月静脉用环磷酰胺联合口服泼尼松的环磷酰胺治疗组(CTX组). 结果 免疫抑制剂治疗6个月后,MMF组和CTX组的完全缓解率和部分缓解率分别为25.0%与16.7%和25.0%与25.0%(P均〉0.05);两组均有8例(8/12,66.7%)患者血清抗PLA2R抗体转阴.治疗12个月末,所有血清抗PLA2R抗体转阴患者均达到了完全或部分缓解.MMF组和CTX组的临床缓解率(包括完全缓解和部分缓解)均为66.7%.免疫抑制剂治疗后,两组患者尿蛋白定量及血清白蛋白均随时间延长而明显改善,但两组间比较差异均无统计学意义(尿蛋白定量:F组内=98.688,P〈0.01;F组间=0.133,P=0.719;F交叉=1.223,P=0.304;血清白蛋白:F组内=30.629,P〈0.01;F组间=0.137,P=0.715;F交叉=0.455,P=0.565).与治疗前比较,治疗6个月和12个月后,两组患者尿蛋白定量[6个月后:MMF组(2 893±2 515) mg/g与(6 236±2 117) mg/g,t=-3.522,P=0.002;CTX组(2 690±2 254) mg/g比(5 386±2 447) mg/g,t=-2.808,P=0.010;12个月后:MMF组1 025(99,4 635) mg/g与(6 236±2 117) mg/g,Z=-3.291,P〈0.0005,CTX组775(41,3 517) mg/g与(5 386±2 447) mg/g,Z=-3.118,P=0.001]及血清白蛋白[6个月后:MMF组(28.5±9.7) g/L与(19.8±4.4) g/L,t=2.841,P=0.012;CTX组(29.0±7.6) g/L与(22.3±4.1) g/L,t=2.690,P=0.016;12个月后:MMF组(32.4±8.5) g/L与(19.8±4.4) g/L,t=4.570,P〈0.0005;CTX组(32.2±7.9) g/L与(22.3±4.1) g/L,t=3.862,P=0.001]均明显好转.结论 对于血清抗PLA2R抗体阳性IMN患者,霉酚酸酯联合激素治疗在使患者抗体转阴和达到临床缓解方面与经典的环磷酰胺联合激素治疗方案一样有效.免疫抑制剂治疗6个月后血清抗PLA2R抗体转阴是预测患者临床缓解的重要标志. Objective To assess the efficacy of mycophenolate mofetil (MMF) combined with prednisone in the treatment of idiopathic membranous nephropathy (IMN) patients with positive serum phospholipase A2 receptor (PLA2R) antibody.Methods An open prospective study was performed on twenty-four biopsy-proven IMN patients with positive serum PLA2R antibody in Guangzhou First People''s Hospital from June 2012 to June 2016.The 24 patients were divided into two groups: MMF group in which MMF combined with prednisone was given for 12 months and CTX group in which intravenous cyclophosphamide (CTX) was monthly given combined with oral prednisone.Results After 6 months of immunosuppressive therapy,complete remission and partial remission rates were 25.0% vs.16.7% and 25.0% vs.25.0% in the MMF group and CTX group,respectively (P〉0.05).In the MMF group and CTX group,serum PLA2R antibody in the same amount (8/12,66.7%) of patients turned negative.At the end of twelve-month treatment,all patients with negative PLA2R antibodies achieved complete or partial remission.Clinical remission (including complete and partial remission) rates in the MMF group and CTX group were both 66.7%.After immunosuppressive therapy,the levels of proteinuria and serum albumin in the two groups were significantly improved,but no significant difference were found between the two groups (proteinuria:F within-grouP=98.688,P〈0.01;F between-grouP=0.133,P=0.719;F cross-grouP=1.223,P=0.304;serum albumin:F within-grouP=30.629,P〈0.01;F between-grouP=0.137,P=0.715;F cros-grouP=0.455,P=0.565).At the end of six and twelve months of treatment,the proteinuria (after six months,MMF group: (2 893±2 515) mg/g vs.(6 236±2 117) mg/g,t=-3.522,P=0.002;CTX group: (2 690±2 254) mg/g vs.(5 386±2 447) mg/g,t=-2.808,P=0.010;after twelve months,MMF group:1 025(99-4 635) mg/g vs.(6 236±2 117) mg/g,Z=-3.291,P〈0.0005;CTX group: (775(41-3 517) mg/g vs.(5 386±2 447) mg/g,Z=-3.118,P=0.001) and serum albumin levels (after six months,MMF group: (28.5±9.7) g/L vs.(19.8±4.4) g/L,t=2.841,P=0.012;CTX group: (29.0±7.6) g/L vs.(22.3±4.1) g/L,t=2.690,P=0.016;at the end of twelve months of treatment,,MMF group: (32.4±8.5) g/L vs.(19.8±4.4) g/L,t=4.570,P〈0.0005;TX group: (32.2±7.9) g/L vs.(22.3±4.1) g/L,t=3.862,P=0.001) of the two groups were better than those prior to treatment.Conclusion For the IMN patients with positive serum PLA2R antibody,MMF combined with prednisone was as effective as conventional CTX combined with prednisone in the negative conversion of PLA2R antibody and the remission.The negative conversion of PLA2R antibody after 6 months of immunosuppressive treatment was an important indicator of predicting the remission.
出处 《中国综合临床》 2017年第7期577-582,共6页 Clinical Medicine of China
基金 广东省科技计划项目(粤科规划字[2011]177号第6项)
关键词 磷脂酶A2受体 膜性肾病 霉酚酸酯 Phospholipase A2 receptor Membranous nephropathy Mycophenolate mofetil
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