霉酚酸酯治疗狼疮肾炎肾病综合征的疗效观察

Efficacy of mycophenolate mofetil therapy in pateints with lupus nephritis

目的 回顾性分析 11例糖皮质激素治疗及 /或环磷酰胺治疗无效 ,或因严重副作用无法治疗的狼疮肾炎肾病综合征患者应用霉酚酸酯 (MMF)联合小剂量激素治疗效果。方法 病理检查证实为狼疮肾炎Ⅳ型患者 11例 ,应用糖皮质激素及环磷酰胺治疗受到限制 ,有中～重度狼疮活动依据 ,改用MMF (1 0～ 2 0 g/d)联合小剂量糖皮质激素治疗 6个月以上 [平均 (8 3± 1 5 )个月 ],同期与继续应用泼尼松及 /或环磷酰胺治疗的狼疮肾炎Ⅳ型患者 8例比较 ,观察尿蛋白、狼疮活动指数及肾功能。结果 经过MMF治疗后 ,尿蛋白由治疗前 (3 9± 0 7)g/d下降到治疗后 (1 4± 0 5 ) g/d ,狼疮活动指数明显下降 (治疗前 13 5± 3 3 ,治疗后 3 8± 1 0 ) ,其中 3例肾功能异常患者肾功能恢复正常 ,与对照组比较尿蛋白、狼疮活动指数恢复差异无显著性。

Objective To investigate the curative efficacy of mycophenolate mofetil therapy in lupus patients with nephrotic syndrome.Methods Eleven cases of biopsy proven active diffuse proliferation lupus nephritis to whom previous oral prednisone and/or intravenous cyclophosphamide treatment had been proven ineffective or who had a refractory course and a bad adverse effect,were enrolled for this trial.Mycophenolate mofetil (MMF) was given at a dosage of 1 0～ 2 0 g/d for 6～13 mouths and lower dosage of prednisone every day.At the same time 8 controls of biopsy proven active diffuse proliferation lupus nephritis with nephrotic syndrome who received continuous prednisone and/or cyclophosphamide treatment over 6 months served for comparing and observing usinary protein,SLEDAI and renal function.Results The urinary protein count and the University of Toronto SLEDAI in patients with diffuse proliferation lupus nephritis decreased significantly by mycophenolate mofetil therapy [urinary protein count from (3 9±0 7) g/d to (1 4±0 5) g/d,the index of illness severity of lupus from 13 5±3 3 to 3 8±1 0 respectively].Conclusion The treatment of mycophenolate mofetil plus small dose glucocorticoids can effectively inhibit the lupus activity of lupus nephritis patients.