摘要
目的:比较霉酚酸酯(MMF)与环磷酰胺(CTX)冲击治疗新月体型IgA肾病(IgAN)的疗效和安全性。方法:经肾活检诊断为新月体型IgAN37例,男女比例为21∶16,年龄在12～50岁之间,随机分为MMF组19例,CTX组18例。两组患者均采用静脉甲基泼尼松龙冲击治疗后口服泼尼松(起始剂量0.8mg/(kg.d))治疗。MMF剂量1.5或2.0g/d,6个月后减量;CTX剂量为0.75g/m2 BSA,每月静脉滴注一次,6个月后改为每3个月一次。两组患者基础临床病理资料无统计学差异。比较两组12个月内的疗效及安全性。结果:(1)MMF组缓解率显著高于CTX组(P<0.05),两组中位缓解时间分别为5个月和8个月。MMF组12个月完全缓解率和总缓解率均显著高于CTX组(66.7%vs25.0%,P<0.05;94.4%vs64.4%,P<0.05)。(2)MMF组12月时尿蛋白水平显著低于CTX组[(0.52±0.47)g/dvs(1.03±0.70)g/d,P<0.05],血浆白蛋白显著高于CTX组[(42.2±3.2)g/Lvs(38.9±5.4)g/L,P<0.05]。两组12月时尿沉渣红细胞计数和血肌酐增高发生率无统计学差异。CTX组1例患者在治疗9个月时出现肌酐倍增。(3)MMF组不良反应包括2例胃肠道不适、1例白细胞低下、1例上呼吸道感染和1例带状疱疹。MMF治疗各项不良反应发生率均低于CTX治疗组。治疗期间CTX组1例患者并发肺部感染退出治疗。结论:MMF治疗新月体型IgAN的近期疗效优于CTX冲击治疗,且不良反应少、耐受性好。
Objective：To compare the clinical efficacy of mycophenolate mofetil （MMF） with pulse cyclophosphamide （CTX） therapy in the treatment of crescentic IgA nephropathy （IgAN）. Methodology：Thirty-seven patients with crescentic IgAN were enrolled in this study. They were divided into MMF or CTX groups randomly. All patients received methylprednisolone （MP） pulse therapy followed by oral prednisolone. MMF group enrolled 19 cases who were treated with MMF at a dosage of 1.5 - 2. 0 g/d. CTX group enrolled 18 cases who were given with CTX 0. 75 g/m^2 BSA monthly for 6 months and then quarterly. The total course was twelve months. The clinical and pathological parameters were compared between the two groups. Results： （ 1 ） Kaplan-Meier life-table analysis revealed a higher remission rate in MMF group than CTX group, with median remission time 5 and 8 months respectively. The complete remission rate and total remission rate were both higher in MMF group after 12 months （66. 7% vs 25.0% , P 〈 0. 05, 94.4% vs 64.4% , P 〈 0. 05 ）. （2） MMF was more effective in improvement of proteinuria and serum albumin, as compared to the control group. One patient developed doubling of the serum creatinine in the CTX group after nine-months, although no difference was presented in the incidence of renal dysfunction between the two groups after 12 months. （3） As to side effects, one patient dropped out for pneumonia in CTX group after four months, while no patient suffered in MMF group. Numerical comparison showed MMF was better tolerated than CTX. Conclusion：MMF therapy may be an effective way for crescentic IgAN.
出处
《肾脏病与透析肾移植杂志》
CAS
CSCD
2007年第5期401-405,413,共6页
Chinese Journal of Nephrology,Dialysis & Transplantation
关键词
IGA肾病
霉酚酸酯
环磷酰胺
疗效
安全性
IgA nephropathy myeophenolate mofetil cyclophosphamide curative effect
