摘要
目的 :主要评价强的松加用环磷酰胺治疗原发性膜性肾病临床疗效及安全性。方法 :12例患者经肾穿刺明确诊断为原发性膜性肾病 ,2 4h尿蛋白定量 >6g ,或 2 4h尿蛋白定量在 3.5～ 6g ,肾病综合征症状突出或出现肾功能不全者给予用药。用药方法强的松 1mg·/kg-1·d-1口服 2个月后 ,每 2周减量 10 % ,至 30mg/d ,每月减量 5mg到维持量。环磷酰胺 0 .8g静脉点滴 ,每月 1次 ,总量2Q 9g。疗效评价 :完全缓解 :2 4h尿蛋白定量 <0 .4g ,血浆白蛋白 >30g/L ,血肌酐恢复正常。部分缓解 :2 4h尿蛋白定量 0 .4～ 1.0g,血浆白蛋白 >30g/d ,血肌酐恢复正常。未缓解 :2 4小时尿蛋白定量 >1.0g,血浆白蛋白 <30g/h ,血肌酐恢复正常或恶化。结果 :12例患者中完全缓解 6例 ,部分缓解 3例 ,无效 3例。总有效率 75 %。治疗过程中一老年患者因加大激素用量而引起肺部感染。肾功能受损 4例 ,3例恢复正常 ,1例无变化。结论 :激素加用环磷酰胺冲击疗法可有效地治疗有大量蛋白尿的膜性肾病。可明显减少蛋白尿 ,提高血浆白蛋白 ,改善肾功能。无明显不良反应。
Objective: The primary nephritic syndrome is main ly caused by the idiopathic membranous nephropathy(IMN). Although there are a vari ety of methods in treating IMN, no best regimen is suggested. This clinical stud y is mainly to evaluate the efficacy and safety of prednisone combined with cycl ophosphamide in treating IMN. Methods: This clinical test en rolled twelve patients, who was definitely diagnosed as IMN by renal biopsy, wit h urinary protein excretion above 3.5g/day, obvious nephritic syndrome or renal failure. The initial dosage of prednisone was 1mg·kg -1·day -1 for t wo months, and then was tapered by 10% every two weeks until to 30mg/day. Finall y the dosage was reduced by 5mg every one month to a maintenance dose. At the sa me time, prednisone was combined with 0.8g cyclophosphamide every one month, and the total amount of cyclophosphamide was less than 9g. During the period, we al so measured urine routine, blood routine, 24-hour proteinuria every two weeks, and liver function, renal function, blood electrolytes and hemagglutination were investigated every one month. The complete remission (CR): proteinuria <0.4g/da y, serum albumin concentration >30g/L and serum creatinine concentration is norm al. The partial remission (CR): proteinuria remain 0.4-1.0g/day, serum albumin concentration is above 30g/day and serum creatinine concentration is normal. The non-remission: proteinuria above 1.0g/day,serun albumin concentration below 30 g/L and serum creatinine concentration is normal or aggravated. Resul ts: In 12 patients, 6 cases achieved CR, 3 patients were PR, and 3 cases were non-remission. The total effective rate was 75%. During the course, an ol d patient got pulmonary infection after increasing the dose of glucocorticostero id because of no obvious change of proteinuria. This clinical study enrolled fou r patients with renal failure. Three of four cases recovered to the normal level , and one case was found no change in renal function.Conclusion: Corticosteroid combined with cyclophosphamide is effective in treating IMN w ith large proteinuria. This method can obviously decrease proteinuria, raise ser um albumin concentration, improve renal function. Meanwhile no obvious side effe ct was found. However, if the clinical syndrome is not obvious, it is not sugges ted to increase the dosage of corticosteroid in order to reduce proteinuria, in case of causing the infection in the old patients.
出处
《中国临床医学》
2004年第6期1064-1065,共2页
Chinese Journal of Clinical Medicine
