激素联合环磷酰胺不同给药方式治疗特发性膜性肾病的临床疗效

Clinical efficacy of different administration methods of hormone combined with cyclophosphamide in the treatment of idiopathic membranous nephropathy

目的 探讨口服糖皮质激素联合静脉滴注环磷酰胺或口服环磷酰胺治疗特发性膜性肾病的临床疗效及安全性.方法 采用前瞻性研究将本院收治的50例患者按随机数字表法分为口服环磷酰胺组(口服组)、静脉注射环磷酰胺组(静点组).口服组予泼尼松口服+复方环磷酰胺片口服治疗,静点组予泼尼松口服+环磷酰胺静脉注射治疗.分别于治疗前、治疗后1、3、6、12个月观察两组患者的24 h尿蛋白定量、血清白蛋白、肝肾功能及不良事件的发生,比较两组患者的缓解率及药物的安全性.结果 治疗3个月时口服组有效率为40%,高于静点组4%,差异有统计学意义(P=0.01);治疗6个月时口服组有效率(52%)高于静点组(44%),治疗12个月时静点组有效率(72%)高于口服组(64%),但差异均无统计学意义(P>0.05).治疗前口服组与静点组白蛋白、尿素氮、肌酐、胱抑素C以及肾小球滤过率、24 h尿蛋白定量间差异均无统计学意义(P>0.05).口服组与静点组治疗12个月时白蛋白水平均明显高于治疗前(P<0.05),24h尿蛋白定量水平明显低于治疗前(P<0.05).静点组较口服组的总不良反应发生率低(P<0.05).结论 激素联合静点CTX治疗特发性膜性肾病的长期疗效更佳,且安全性更高.

Objective To investigate the clinical efficacy and safety of oral glucocorticoid combined with intravenous cyclophosphamide or oral cyclophosphamide in the treatment of idiopathic membranous nephropathy.Methods According to the random number table method,50 patients in our hospital were divided into oral cyclophosphamide group(oral group)and intravenous cyclophosphamide group(intravenous group).The oral group was treated with prednisone and compound cyclophosphamide tablets,while the intravenous group was given prednisone and intravenous injection of cyclophosphamide.The 24-hour urinary protein,serum albumin,liver and kidney function and adverse events were observed before treatment and 1,3,6 and 12 months after treatment.The remission rate and drug safety of the two groups were compared.Results After 3 months of treatment,the effective rate of oral group was 40%,which was significantly higher than that of intravenous group(4%).After 6 months of treatment,the effective rate of oral group(52%)was higher than that of intravenous group(44%).After 12 months of treatment,the effective rate of intravenous group(72%)was higher than that of oral group(64%),with no statistically significant difference(P>0.05).Before treatment,there were no significant differences in albumin,urea nitrogen,creatinine,Cystatin C,glomerular filtration rate and 24-hour urine protein between the oral group and the intravenous group(P>0.05).After 12 months of treatment,the level of albumin in the oral group and the intravenous group was significantly higher than that before treatment(P<0.05),and the 24-hour urine protein level was significantly lower than that before treatment(P<0.05).The total incidence of adverse reactions in the intravenous group was lower than that in the oral group(P<0.05).Conclusions Hormone combined with intravenous infusion of cyclophosphamide has better long-term efficacy and higher safety in the treatment of idiopathic membranous nephropathy.