霉酚酸酯对狼疮性肾炎的治疗效果及肾脏病理分析

The effect of mycophenolate mofetil on lupus nephritis and kidney pathology

目的研究探讨霉酚酸酯(MMF)对狼疮性肾炎(LN)的临床治疗效果。方法收集2008年1月至2017年12月于本院治疗的40例LN患者,应用数字随机表法将其随机分为两组,每组20例。对照组采用环磷酰胺治疗,观察组采用霉酚酸酯治疗,比较两组的临床疗效、不良反应、治疗前后的疾病活动度指数、肾功能指标及肾脏病理指标。结果两组的总有效率比较差异无统计学意义(P>0.05),观察组的总有效率高于对照组(P<0.05)。治疗前,两组的疾病活动度指数、血肌酐(Scr)、尿素氮(BUN)、24 h尿蛋白、纤维新月体、白金耳和微血栓差异均无统计学意义(P>0.05),治疗后,与对照组比,观察组的疾病活动度指数、BUN、Scr、24 h尿蛋白和总不良反应发生率均明显降低(P<0.05)。两组患者的纤维新月体、白金耳和微血栓均明显降低,但组间比较差异无统计学意义(P>0.05)。结论霉酚酸酯治疗狼疮性肾炎可以达到与环磷酰胺相当的临床疗效,霉酚酸酯相比于环磷酰胺可以减少患者不良反应,其安全性更加安全可靠。

Objective To study the clinical effect of mycophenolate mofetil(MMF)on lupus nephritis(LN)and kidney pathology.Methods From January 2008 to December 2017,40 patients with lupus nephritis were randomly divided into 2 groups,20 cases in the control group and 20 cases in the observation group.The control group was treated with cyclophosphamide and the observation group was treated with mycophenolate mofetil based on the control group.The clinical efficacy and adverse reactions of 2 groups were collected after treatment.The disease activity index,renal function index and renal pathological index were compared before and after treatment.Results There was no significant difference in the total effective rate between 2 groups(P>0.05).The total effective rate of the observation group was higher than that of the control group(P<0.05).Before treatment,there was no statistical difference in disease activity index,serum creatinine(Scr),blood urea nitrogen(BUN),24 h urine protein,fibrin crescent,platinum ear and microthrombus(P>0.05).After treatment,compared with the control group,the disease activity index,BUN,Scr,24 h urine protein and total adverse reaction rate of the observation group had decreased significantly(P<0.05).The fiber cre-scent,white gold ear and microthrombus had significantly decreased in 2 groups after treatment,but the difference between 2 groups had no statistically differences(P>0.05).Conclusions Mycophenolate mofetil can achieve the same clinical effect as cyclophosphamide in the treatment of lupus nephritis.Compared with cyclophosphamide,mycophenolate mofetil can reduce the adverse reaction of patients,and its safety is more reliable.