摘要
目的 比较霉酚酸酯（ＭＭＦ）与间断性环磷酚胺静脉冲击疗法（ＣＴＸ）治疗狼疮肾炎（ＬＮ）的近期及远期疗效、不良反应及安全性。方法Ａ组：间断性环磷酞胺冲击疗法治疗３０例ＬＮ患者，平均随访（１８６５±６．１０）（６～２４）月． Ｂ组：ＭＭＦ联合激素治疗ＬＮ患者，平均随访（２１.８９±７. ４８）（６～４８）月．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ＬＮ均能降低蛋白尿和血尿，改善肾功能及免疫指标，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、性腺抑制副反应，感染率为 １３．３％。ＣＴＸ组感染率为 ２３．３％．肝功能受累为 ２３.３％，性腺抑制为 ２８％．结论 ＣＴＸ、ＭＭＦ都能有效的控制狼疮肾炎，改善肾功能，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治疗后达到与ＣＴＸ组同样效果，而且副作用少，提示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 lupus nephritis. Methods A group (CTX group): 30 patients were given intravenous cyclophosphamide (0.5 -0.75 g/m^2) pulse plus oral prednisone. All patients were treated for (18. 65 ±6. 10) (6 -24) months. B group (MMF group): 30 patients were given MMF at a dosage of 1. 0 -1. 5 g/d and oral prednisone. All patients were treated for (21. 89±7. 48) (6-48) 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 hematuria, and improved renal function and immune indexes 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 ontcome of two groups was similar. Liver toxicity and amenorrhea were not observed, while infections(13. 3% ), herpes zoster(6. 7% ), leukopenia(3. 3% ) were found during MMF treatment. And in CTX group, liver toxicity(23. 3% ), amenorrhea(28% ), infections(23. 3% ), herpes zoster( 10% ), leukopenia (10% ) occurred. Conclusion For the treatment of lupus nephritis, the combination of mycophenolate mofetil and prednisone is as effective as the regimen of cyclophosphamide and prednisone but less toxicity.
出处
《中华肾脏病杂志》
CAS
CSCD
北大核心
2002年第1期21-24,共4页
Chinese Journal of Nephrology
