摘要
目的观察吗替麦考酚酯（MMF）联合氟伐他汀（LESCOL）治疗原发性难治性肾病综合征（IRNS）的临床疗效、副作用和复发率。方法62例IRNS患者随机分为两组，一组采用MMF联合联合氟伐他汀治疗（MMF＋LESCOL组，n=31），另一组采用CTX间断静脉冲击治疗（CTX组，n=31）。两组患者均给予甲基泼尼松龙静脉冲击后口服泼尼松，MMF剂量1.0或1．5g／d，疗程均／〉6个月，氟伐他汀40mg，每晚一次口服，疗程〉19个月；CTX剂量为12～20mg／kg，每月静脉滴注一次，6个月后改为每3月一次，疗程≥12个月，通过观察患者尿蛋白量、血白蛋白（ALB）、血肌酐（Scr）、血胆固醇（TC）的变化，比较两组缓解率、副作用发生率及复发率。结果疗效：①完全缓解率MMF＋LESCOL组（54．8％）显著高于CTX组（35．5％），P〈0．01，显著缓解率MMF＋LESCOL组（25．8％）显著高于CTX组（16．1％）（P〈0．01，总缓解率MMF＋LESCOL组（90．3％）高于CTX组（67．7％），P〈0．05。MMF＋LESCOL组尿蛋白明显下降及血浆白蛋白回升与CTX组相较有显著性差异（P〈0．01）。②副作用：副反应率MMF＋LESCOL组（9．7％）显著低于CTX组（51．6％），P〈0．01。③复发：复发率MMFq-LESCOL组（9．7％）显著低于CTX组（32．3％），P〈0．01。结论与CTX静脉冲击治疗相比较，MMF联合LESCOL治疗IRNS缓解率高，能更有效降低蛋白尿，副作用发生率和复发率低，是目前治疗IRNS一种较好的方法。
Objective To observe the clinical efficacy of mycophenolate mofetil（MMF） and fluvastatin（LESCOL） in the treatment of Idiopathic Refractory Nephrotic Syndrome（IRNS）. Method Sixty- two patients with IRNS proven clinically and histologically were enrolled into this study. They were divided into MMF and LESCOL group or CTX group . MMF and LESCOL group included 31 cases who were treated with MMF at a dosage of 1.0 ~ 1.5g/d, for at least 6 months. They also received LESCOL 40mg/d for at least 9 months. CTX group enrolled 31 cases who were geven cyclophosphamide 12 - 20mg/kg monthly 6 months and then quarterly 2 quarters. All patients in both groups also received methylprednisolone（MP） pulse therapy followed by oral prednisone . The quantity of urinary protein , serum albumin, serum creatinine, serum cholesterol was meaxured. The remission rate, drug - rela - ted side effect and recurrence rate were compared between the two groups. Results （~）Cur- ative effect：The complete remission rate of MMF ＋ LESCOL group （54. 8% ） was significantly higher than that of CTX group（35.5% ） ,P 〈 0.01. The signal remission rate of MMF ＋ LESCOL group （25. 8% ） was significantly higher than that of CTX group （ 16. 1% ）, P 〈 0. 01. The total remission rate of MMF ＋ LESCOL group（90. 3% ） was higher than tha, of CTX group（67.7% ） ,P 〈0. 05. MMF ＋ LESCOL group showed decrease the quantity of urinary protein increase of serum albumin as compared with CTX group with statistical significance. P 〈 0.01 （2）Side effect：The adverse reactions rate of MMF ＋ LESCOL group （9.7%）was significantly lower than that of CTX group （51.6 % ）, P 〈 0. 01. （3）Recnrrence：The recurrence rate of MMF ＋ LESCOL group （9. 7% ） was significantly lower than that of CTX group （32. 3% ）, P 〈 0. 01. Conclusion The combination therapy of MMF and LESCOL was more effective than CTX pulse therapy in patients with IRNS. MMF and LESCOL could have more efficacy in reducing proteniuria wi
