霉酚酸酯对难治性肾病综合征和弥漫增殖性狼疮肾炎的疗效比较

Mycophenkplte Mofetil in the Treatment of Primary Refractory Nephrotic Syndrome and Type Ⅳ Lupus Nephritis

目的 :观察霉酚酸酯 (MMF)在治疗原发性难治性肾病综合征与弥漫增殖性狼疮性肾炎的疗效比较。方法 :观察难治性肾病综合征 15例及同期弥漫增殖性狼疮性肾炎 (ⅣLN) 18例。以强的松 0 .4mg～ 0 .7mg·kg-1·d-1联合MMF1.0～ 1.5 2次 /d ,3～ 6个月后减半维持 1年 ,定期随访。结果 :以强的松联合MMF治疗 ,对ⅣLN疗效良好 ,完全缓解率达 10 0 % ,其中 3个月内缓解 12例 ,6个月内缓解 17例。而在原发性肾病综合征中 ,对MCD和MsPGN疗效良好 ,与ⅣLN相似 ,在MN中 2例完全缓解 ,3例仅部分缓解 ,2例无效。而后者均在 6～ 9个月间 ,对FSGS和MPGN仅 1例在 9个月后部分缓解 ,2例无效。结论 :MMF对MCD和MsPGN效果良好 ,对MN显示部分疗效 ,对FSGS和MPGN的疗效较差。总体上MMF对难治性肾病综合征的疗效逊于ⅣLN。

Objective:To compare the theraputic effect of mysophenolate moretil(MMF)in the treatment of primary refractory nephrotic stndrome and ⅣLN.Methods:Fifteen patients with refractory nephrotic syndrome were cerifyed by renal biopsy,including 2 patients with,minimal change disease(MCD),3 with membranous nephropathy (MN), 2 with focal segmental glomerulosclerosis,1 with membranoproliferative glomreualonephritis (MPGM).Eighteen patients with type Ⅳ lupus nephritis(ⅣLN)were also included. Corticosteriod (0.4～0.7mg·kg -1 ·d -1 ) and MMF (1.0～1.5次/d) were given for 3-6 months and the dosage was lowered by half and were maintained for 1 year.Results:The theraputic effect of corticosteriod and MMF in treating patients with ⅣLN was good with 100% complete remission.12 patients had complete remission in 3 months.17 patients had complete remission in 6 months. The theraputic effect is oimilar between patients with primary nephrotic syndrome of MCD of MSPGN and patients with ⅣLN.In patients with MN,2 patients had complete remission and 3 patients had partial remission during 6～9 months.In patients with FSGS or MPGN, only 1 had partial remission after 9 months,2 patients remained nephrotic.Conclusion:The theraputic effect of MMF in the treatment of MCD and MSPG is good but it is poor for NM,FSGS and MPGN.In general,the theraputic effect of MMF in the treatment of refracfory nephrotic syndrome is less effective than that ⅣLN