强的松联合环磷酰胺冲击治疗伴有新月体形成的IgA肾病

Prednisone combining cyclophosphamide implosion therapy for IgA nephropathy associated with crescentic change

目的 探讨伴有新月体形成的IgA肾病的有效治疗方案。 方法 对 8例伴有新月体形成的IgA肾病患者实行强的松口服 (初始剂量每天 1mg/kg)联合环磷酰胺冲击治疗 (初始为每天 8～ 12mg/kg ,连续两天作为一次冲击 ,每两周冲击一次 )。观察治疗前后 2 4小时尿蛋白定量、血肌酐 (Scr)和内生肌酐清除率 (CCr)的变化。结果 治疗 8～ 16周后 ,2 4小时尿蛋白定量由初始的 (5 .68± 1.3 4) g减少为 (1.13± 0 .2 4) g(P <0 .0 1) ,Scr由初始的 (15 8.4± 14 .9) μmol/L降低至(113 .8± 7.4) μmol/L(P <0 .0 1) ,Ccr由初始的 (4 8.4± 8.2 )ml/min上升至 (85 .8± 9.3 )ml/min(P<0 .0 1)。 3例重复肾活检的患者新月体消失。所有患者血尿减轻。结论 强的松联合环磷酰胺冲击疗法 。

abstract Objective To investigate effective therapy for IgA nephropathy associated with crescentic change.Methods Eight patients with IgA nephropathy associated with crescentic change were treated by oral prednisone (initial dose 1mg/kg daily) and cyclophosphamide implosion therapy (initial dose 8～12mg/kg daily, two consecutive days as one implosion therapy, every two weeks for one course).The changes of 24 hour urine total protein, serum creatinine (Scr) and creatinine clearance (Ccr) were monitored.Results After treatment for 8～16 weeks,24 hour total protein decreased from initial 5.68±1.34 g to 1.13±0.24 g( P <0.01),Scr decreased from initial(158.4±14.9)μmol/L to(113.8±7.4)μmol/L( P <0.01),Ccr increased from initial(48.4±8.2)ml/min to(85.8±9.3)ml/min( P <0.01)?The crescents in three cases, which had the second renal biopsies, disappeared. The degree of hematuria in all of cases lessened.Conclusion Prednisone combining cyclophosphamide implosion therapy is effective and safe for IgA nephropathy associated with crescentic change.