环孢素A治疗难治性肾病综合征的临床观察

A Clinical Observation on the Effect of Cyclosporin A in the Treatment of Refractory Nephrotic Syndrome

目的 :研究环孢素A(CsA)治疗原发性难治性肾病综合征的疗效及安全性。方法 :2 1例患者均行肾活检检查 ,其中系膜增殖性肾小球肾炎 (MsPGN) 13例 ,膜性肾病 (MN) 6例 ,膜增殖性肾小球肾炎 (MPGN) 2例。采用皮质激素和CsA联合治疗 ;CsA初始剂量 5mg·kg-1·d-1,3个月后适当减量 ,疗程 1年以上。强的松开始剂量 1mg·kg-1·d-1,8周后逐渐减量 ,疗程也在 1年以上。结果 :CsA联合皮质激素 ,使系膜增殖性肾小球肾炎和膜性肾病患者蛋白定量下降 ,血清白蛋白上升 (P<0 .0 1)。 13例系膜增殖性病变患者中 4例在第 4周起效 ,11例获完全缓解。 6例MN患者中 ,3例第 8周见效 ,4例获完全缓解 ,1例部分缓解 ,1例无效。膜增殖性肾炎患者 1例部分缓解 ,1例无效。治疗前后肾功能无变化。结论 :CsA是治疗难治性肾病综合征有效的免疫抑制剂 ,对于CsA的适应症。

Objective: To investigate the efficacy and safety of Cyclosporine A(CsA) in treating refratory primary nephrotic sydrome. Methods: Twenty one patients with refractory nephrotic syndrome confirmed by renal biopsy, 13 with mesangial proliferative glomerulonephritis (MsPGN), 6 with membranous nephropathy (MN), and 2 with mesangioproliferative glomerulonephritis(MPGN), were treated by CsA combined with prednisone. The initial dosage of CsA was 5 mg·kg -1 ·d -1 for three months and then the dosage was tapered gradually. The duration of CsA treatment was at least one year. Prednisone at the dose of 1 mg·kg -1 ·d -1 was used at the beginning of the combined treatment and then the dosage was tapered gradually eight weeks later. The duration of prednisone treatment was at least one year too. Results: The combined treatment of CsA and prednisone decreased the urine protein and elevated the serum albumin significantly among patients with MsPGN and MN (P<0.01). Four of thirteen patients with MsPGN responded within four weeks, and eleven of them obtained complete clinical remission. Three of the six patients with MN achieved remission within eight weeks, and four of them obtained complete clinical remission. One of the two patients with MPGN achieved partial remission. Renal function remained stable during the treatment. Conclusion: CsA is an effective and safe immunosuppressive agent for refratory nephrotic sydrome.