环孢素A联合环磷酰胺治疗狼疮肾炎的疗效观察

Treatment of lupus nephritis with combined cyclosporine A and cyclophosphamide

目的 探讨环孢素A(CsA)联合环磷酰胺 (CTX)治疗增生型狼疮肾炎 (PLN)的效果。方法 将1 1 7例PLN患者分为 4组 ,A组 (30例 ) :首次确诊为PLN ,予泼尼松和CTX治疗 ;B组 (2 1例 ) :首次确诊为PLN ,予泼尼松和CsA治疗 ;C组 (2 1例 ) :首次确诊为PLN ,予泼尼松、CsA和CTX治疗 ;D组 (45例 ) :难治性PLN ,予泼尼松、CsA和CTX治疗。观察患者的LN活动指数、复发率和副作用。结果 A组和C组的疗效和复发率相似 ,均优于D组 ;C组和D组除高血压、牙龈增生和血尿酸升高的发生率高于A组外 ,其余副作用在 3组间无明显区别。B组在CsA减量或停药后 ,复发率明显高于其余 3组 ,但改用A组方案仍有效。结论 CsA联合CTX能有效治疗PLN 。

Objective To investigate the effect of treatment with combined cyclosporine A and cyclophosphamide on proliferative lupus nephritis (PLN).Methods One hundred and seventeen PLN patients were divided into 4 groups.Group A:30 patients with initiative PLN were treated with combined cyclophosphamide and prednisone.Group B:21 patients with initiative PLN were treated with combined cyclosporine A and prednisone.Group C:21 patients with initiative PLN were treated with combined cyclosporine A,cyclophosphamide and prednisone.Group D:45 patients with refractory PLN were treated with combined cyclosporine A,cyclophosphamide and prednisone.All patients were followed up for one year,and outcome,relapse and side effects were recorded.Results Outcome and relapse rate were similar in group A and group C,but were all better than those in group D.Except that the incidence of hypertension,gingival hyperplasia and hyperuricemia was higher in group C and group D than that in group A,other side effects were similar in these three groups.Relapses occurred in most of the patients in group B when cyclosporine A was tapered or withdrawn,but still could be treated effectively with combined cyclophosphamide and prednisone.Conclusion PLN could be effectively treated with combined cyclosporine A and cyclophosphamide,even the refractory PLN.