摘要
目的:糖皮质激素(简称激素)是特发性膜性肾病(IMN)免疫抑制治疗的一线用药。通过分析不同的激素应用方法治疗IMN的疗效为其治疗提供线索。方法:收集大连医科大学附属第一医院肾内科2002年1月—2014年1月住院的246例IMN患者,根据治疗方法分为两组。静脉冲击组给予静滴甲泼尼龙500 mg,持续3 d,3 d后再足量激素起始口服,口服组予以足量激素起始口服。观察静脉冲击组和口服组治疗前及治疗2个月后的肾功、肝功、24 h尿蛋白定量等指标。结果:治疗2个月后,静脉冲击组与口服组比较,尿蛋白定量、白蛋白、血肌酐和血糖等指标,差异无统计学意义(P>0.05)。根据两组患者的缓解例数,说明静脉冲击组疗效更好。静脉冲击组:完全缓解率3.70%,部分缓解率70.37%,无效率25.93%。口服组:完全缓解率4.16%,部分缓解率37.50%,无效率58.33%。结论:激素在IMN的早期治疗是部分有效的,可使尿蛋白下降,能缓解肾病进展。激素大剂量静脉冲击后再序贯口服与直接口服激素治疗IMN相比,具有更高的缓解率,能更好地保护肾功能。
Objective:Glucocorticoids(hormones for short)are first-line drugs for immunosuppressive therapy in idiopathic membranous nephropathy(IMN).By analyzing the efficacy of different application methods of hormones in the treatment of IMN,clues are provided for its treatment.Methods:246 patients with IMN admitted to the hospital from January 2002 to January 2014 were collected as research subjects.The intravenous pulse group was given intravenous methylprednisolone 500 mg for 3 d,and then a sufficient amount of hormones was started orally after 3 d.The oral group was given enough hormones to start oral adminis⁃tration.The renal function,liver function,24-hour urine protein quantification and other indicators were observed in the intrave⁃nous pulse group and the oral group before treatment and after 2 months of treatment.Results:After 2 months of treatment,there was no statistically significant difference in the quantitative urine protein,albumin,serum creatinine and blood glucose between the intravenous pulse group and the oral group(P>0.05).According to the number of remission cases in the two groups,it showed that the venous pulse group has better curative effect.In the venous pulse group:the complete remission rate was 3.70%,the partial re⁃mission rate was 70.37%,and the ineffective rate was 25.93%.Oral group:the complete remission rate was 4.16%,the partial re⁃mission rate was 37.50%,and the ineffective rate was 58.33%.Conclusion:Hormones are partially effective in the early treatment of IMN,which can reduce urinary protein and alleviate the progression of renal disease.Compared with direct oral hormone therapy for IMN,high-dose intravenous pulse of hormone followed by sequential oral administration has a higher remission rate and better protection of renal function.
作者
陈雁
CHEN Yan(Chinese People’s Liberation Army Army Characteristic Medical Center,Chongqing,401120,China)
出处
《黑龙江医学》
2022年第11期1307-1310,共4页
Heilongjiang Medical Journal
关键词
糖皮质激素
特发性膜性肾病
冲击治疗和口服治疗
Glucocorticoids
Idiopathic membranous nephropathy
Intravenous pulse therapy and oral therapy
