激素联合雷公藤多苷治疗成人特发性膜性肾病疗效与血清抗PLA2R抗体水平的关系

The Relationship Between the Therapeutic Effect of Glucocorticoid Combined with Tripterygium Wilfordii Glycoside in Idiopathic Membranous Nephropathy in Adults and Level of Serum Anti PLA2R Antibody

目的:探讨在激素联合雷公藤多苷治疗成人特发性膜性肾病(IMN)疗效与血清抗PLA2R抗体水平的关系。方法:61例成人IMN患者,采用间接免疫荧光法(IIFT)检测血清抗PLA2R抗体,根据血清抗PLA2R抗体检测结果分为血清抗PLA2R抗体阳性组(n=40)和血清抗PLA2R抗体阴性组(n=21),两组均予激素联合小剂量雷公藤多苷治疗,观察其疗效与血清抗PLA2R抗体的关系。结果:两组第1、3、6个月完全缓解率均呈升高趋势,与血清抗PLA2R抗体阳性组相比,血清抗PLA2R抗体阴性组第3个月完全缓解率(26.1%vs 5.8%)及第6个月总有效率(82.60%vs 55.80%)显著高于血清抗PLA2R抗体阳性组,差异具有统计学意义(P<0.05)。上呼吸道感染及肝功能异常是其主要的不良事件,但发生率两组无差异。结论:激素联合雷公藤多苷治疗IMN的疗效与血清血清抗PLA2R抗体水平有关,对血清抗PLA2R抗体阴性者疗效较好。

Objective:To study the relationship between the therapeutic effect of glucocorticoid combined with Tripterygium wilfordii glycoside.In idiopathic membranous nephropathy(IMN)in adults and level of serum anti PLA2R antibody.Methods:61 patents witn IMN were divided into two groups according serum anti PLA2R antibody:positive group(n=40)and negative group(n=21).Serum anti PLA2R antibody was detected by indirect immunofluorescence.All patients were treated with glucocorticoid combined with low dose Tripterygium wilfordii glycoside.Results:The rate of complete remission increased gradually at 1、3 and 6 months in two groups.The complete remission at 3 months(26.1%vs 5.8%)and effective rate at 6 months(82.60%vs 55.80%)in serum anti PLA2R antibody negative group were obvious higher than those in serum anti PLA2R antibody positive group(P<0.05)Mild upper respiratory tract infection and liver dysfunction were major adverse events.The incidence of adverse events was significant diffenrcnce.Conclusion:Curative effect of glucocorticoid combined with Tripterygium wilfordii glycoside.in adult IMN is better in serum anti PLA2R antibody negative group.