霉酚酸酯与环磷酰胺冲击治疗成人难治性原发性肾病综合征临床疗效比较观察

CLINICAL STUDY MYCOPHENOLATE MOFETIL THERAPY VERSUS INTERMITTENT CYCLOPHOSPHAMIDE PULS TREATMENT IN ADULT REFRACTORY

目的 :比较霉酚酸酯 (MMF)与间断性环磷酰胺 (CTX)静脉冲击疗法治疗成人难治性原发性肾病综合征(RNS)的近期及远期疗效、不良反应及安全性。方法 :A组 :间断性环磷酰胺冲击疗法治疗 31例RNS患者。B组 :MMF联合激素治疗RNS患者。两组患者的病理类型、病情基本相似 ,但B组 (MMF)绝大部分为皮质激素联合CTX治疗无效者 ,B组患者病程明显较A组长。结果 :CTX组、MMF组治疗KNS均能降低蛋白尿 ,改善肾功能 ,提高血浆白蛋白 ,两组间差异无显著性意义。MMF组患者的平均疗程较CTX组明显延长 ,而疗效却基本相同。不良反应 :MMF组无肝功能受累 ,感染率为 16 .1%。CTX组感染率为 2 9.0 % ,肝功能受损为 2 5 .8%。结论 :CTX ,MMF都能有效地控制RNS ,两者无显著性差异。对病程长、激素联合CTX无效及病情迁延者 ,经MMF治疗后可达到与CTX组同样的效果 ,而且副作用少 ,显示MMF具有一定的优越性。

Objective:To evaluate the therapeutic effect and side-effect between pulse cyclophosphamide (CTX) therapy and mycophenolate mofetil(MMF) in adult refractory nephrotic syndrome. Methods:A group(CTX group): 31 patients were given intravenous cyclophosphamide pulse plus oral prednisone. B group(MMF) all patients were given MMF and oral prednisone. All patients were treated for same months. Patients in two groups were comparable in age, sex distribution, severity of renal damage. Most patients in B group were refractory to cyclophosphamide therapy, and their histories were much longer than those of A group. Results:CTX and MMF both reduced proteinuria and improved renal function, CTX and MMF were effective on inhibiton of autoantibodies production. The mean therapeutic period of B group was significantly longer than that of A group, but the outcome of two group was similar. Liver toxicity was not observed, while infections(16%), herpes zoster(3.2%), leukopenia(3.2%) were found during MMF treatment. And in CTX group, liver toxicity(25.8%).Conclusion:For the treatment of refractory nephrotic syndrome, the combination of mycophenolate mofetil and prednisone is as effective as the regimen of cyclophosphamide and prednisone but less toxicity.