不同剂量激素联合环磷酰胺冲击疗法治疗膜性肾病的临床效果

Clinical effect of hormone at different doses combined with Cyclophosphamide pulse therapy in the treatment of membranous nephropathy

目的探讨不同剂量激素联合环磷酰胺冲击疗法治疗膜性肾病的效果。方法选择我院2016年1月~2018年6月收治的32例膜性肾病患者,采用随机数字表法分为两组,各16例。两组均行环磷酰胺冲击疗法,基于此,对照组给予足剂量激素[1 mg/(kg·d)醋酸泼尼松龙片],观察组给予中等剂量激素[0.5mg/(kg·d)醋酸泼尼松龙片]。比较两组临床疗效、血脂指标、骨密度测定值降低时间以及不良反应。结果治疗后,两组总缓解率及血清肌酐(Cr)水平比较,差异无统计学意义(P>0.05);治疗后,两组的总胆固醇(TC)、三酰甘油(TG)以及低密度脂蛋白(LDL)水平均低于治疗前,且观察组的TC、TG以及LDL水平低于对照组,差异均有统计学意义(P<0.05);观察组骨密度测定值降低时间晚于对照组,不良反应总发生率低于对照组,差异均有统计学意义(P<0.05)。结论足剂量激素与中等剂量激素联合环磷酰胺冲击疗法治疗膜性肾病效果相当,但使用中等剂量激素可有效调节血脂水平,延缓骨质疏松,降低不良反应发生率。

Objective To investigate the effect of hormone at different doses combined with Cyclophosphamide pulse therapy in the treatment membranous nephropathy.Methods Totally 32 patients with membranous nephropathy admitted into our hospital from January 2016 to June 2018 were selected.They were divided into two groups by a random number table,16 cases in each group.Both groups received Cyclophosphamide pulse therapy.Based on that,the control group was given a sufficient dose of hormone[1 mg/(kg·d)Prednisolone acetate tablets],and the observation group was given a medium dose of hormone[0.5 mg/(kg·d)Prednisolone acetate tablets].The clinical efficacy,blood lipid indexes,the time of bone mineral density reduction,and adverse reactions were compared between the two groups.Results After treatment,the total remission rate and serum creatinine(Cr)level of the two groups had no significant differences(P>0.05).After treatment,the total cholesterol(TC),triglycerides(TG)and low-density lipoprotein(LDL)levels were lower than those before treatment,and the levels of TC,TG,and LDL in the observation group were lower than those of the control group,and the differences were statistically significant(P<0.05).The time of bone mineral density reduction in the observation group was later than that of the control group,and the total incidence of adverse reactions was lower than that of the control group,the differences were statistically significant(P<0.05).Conclusion Combined with Cyclophosphamide pulse therapy,the adequate-dose hormone treatment and the medium-dose hormone treatment have equivalent effect on membranous nephropathy,but using medium-dose hormone treatment can effectively regulate blood lipid levels,delay the occurrence of osteoporosis,and reduce the incidence of adverse reactions.