单用泼尼松或联合吗替麦考酚酯治疗C3肾小球肾炎的疗效

Prednisone alone or combine with mycophenolate mofetil in treatment of C3 glomerulonephritis

目的:探索两种方案治疗C3肾小球肾炎(C3GN)的疗效。方法:回顾性分析东部战区总医院国家肾脏疾病临床医学研究中心经肾活检明确诊断为C3GN的病例,比较泼尼松联合吗替麦考酚酯(Pred+MMF)与单用泼尼松(Pred)两种治疗方案肾脏缓解率和预后的差别。结果:(1)Pred+MMF治疗组8例,男女比例3∶5,中位年龄19岁(16～27岁),Pred治疗组19例,男女比例11∶8,中位年龄33岁(19～45岁)。两组基线临床资料和组织形态学特点无统计学差异;(2)Pred+MMF组中位随访时间43月,肾脏缓解率37.5%,1例进展至随访终点,Pred组中位随访时间41.5月,肾脏缓解率52.9%,2例进展至随访终点;两组肾脏缓解率和预后均无统计学差异;(3)11例进行了补体相关抗体检测,仅1例C3肾炎因子阳性,3例行补体相关基因检测,未发现突变。(4)两组分别有1例出现感染。结论:Pred+MMF对部分C3GN治疗有效,但疗效并不优于单纯Pred治疗。

Objective:To evaluate the therapeutic efficacy of prednisone with mycophenolate mofetil(Pred+MMF) and prednisone(Pred) alone in patients with C3 glomerulonephritis(C3 GN). Methodology:we conducted a retrospective analysis of patients with C3 GN confirmed by renal biopsy,8 patients received Pred+MMF treatment,19 patients received Pred treatment.We compared remission and prognosis of two groups. Results:(1) there were 3 males and 5 females with median age of 19(16~27) years old in Pred+MMF group.11 males and 8 females were treated with Pred alone,with the median age of 33(19~45) years old.There were no significant differences in baseline clinical data and histomorphological features between the two groups.(2) The median follow-up time was 43.5% in the Pred+MMF group,and the renal remission rate was 37.5%.One patient reached the primary endpoint.The median follow-up time in the Pred group was 41.5 months.The renal remission rate was 52.9%,and 2 patients reached the primary endpoint.There was no significant difference in renal remission rate and prognosis between the two groups.(3) 1/11 patients were positive for C3 Nef.Three patients underwent genetic testing,none of them with genetic variants in complement genes(4) There were few adverse reactions of immunosuppressive agents,and one patient in each group had infection. Conclusion:Pred+MMF is effective in the treatment of some C3 GN,but the curative effect is not better than prednisone regimen alone.