摘要
目的观察不同治疗方案对特发性膜性肾病(IMN)治疗的短期疗效,探讨中等量激素联合环孢素对本病治疗的价值。方法回顾性分析阜阳市人民医院经肾活检明确诊断的IMN患者79例,依据治疗方案不同,分为对症治疗组、改良意大利方案治疗组、中等量激素联合环孢素A(CsA)治疗组,比较3组方案治疗6个月的疗效及不良反应。结果 (1)对症治疗组患者尿蛋白定量显著低于改良意大利方案治疗组和中等量激素联合CsA治疗组。(2)3组患者治疗6个月后尿蛋白均显著减少,血浆白蛋白显著升高。(3)治疗6个月后对症治疗组、改良意大利方案治疗组、中等量激素联合CsA治疗组缓解率分别达到72.0%、79.4%、73.3%,组间无统计学差异(P>0.05),但改良意大利方案治疗组患者较多患者出现肝酶增高(16.0%∶56.4%∶26.7%,P<0.05)。结论不同临床表现的IMN患者应选择不同的治疗方案,中等量激素联合CsA治疗组短期疗效与改良意大利方案治疗无显著差异,但转氨酶损伤风险较小,可以作为IMN治疗优选方案之一。
Objective To observe the short-term clinical efficacy of different treatment regimens for idiopathic membranous nephropathy (IMN);and to explore the value of combination of moderate-dose hormones with cyclosporines for treatment of this disease. Methods A retrospective analysis was performed in 79 cases of patients with IMN diagnosed by renal biopsy in Fuyang People’s Hospital.Based on treatment regimens,the patients were divided into the symptomatic treatment group,the modified Ponticelli regimen group,and the moderate-dose hormones plus cyclosporines group Efficacy and adverse reactions were compared among the three groups after 6 months of treatment. Results (1) The quantity of urinary protein in the symptomatic treatment group was significantly lower than that in the modified Ponticelli regimen treatment group and in the moderate-dose hormones plus cyclosporines treatment group.(2)After treatment for 6 months,the urinary protein levels were significantly decreased in the three groups,while the plasma albumin was significantly increased.(3) After treatment for 6 months,the symptomatic remission rates in the symptomatic treatment group,in the modified Ponticelli regimen treatment group and in the moderate hormones plus cyclosporines treatment group were 72.0%,79.4% and 73.3% respectively,with no statistically significant difference between the three groups ( P >0.05);but in the modified Ponticelli regimen treatment group,more patients had higher levels of hepatic enzymes (16%: 56.4%: 26.7%, P <0.05). Conclusions IMN patients with different clinical manifestations should choose different treatment regimens.The short-term clinical efficacy in the moderate-dose hormones plus cyclosporines treatment group is not significantly different from that in the modified Ponticelli regimen treatment group,but has smaller risk for transaminase liver impairment,and so may act as one of preferable treatment regiments for IMN.
作者
李小伟
梅冬冬
王显
胡本金
LI Xiao-wei;MEI Dong-dong;WANG Xian;HU Ben-jin(Department of Nephrology,Fuyang People’s Hospital,Fuyang,236000,China)
出处
《临床肾脏病杂志》
2019年第3期162-165,共4页
Journal Of Clinical Nephrology
基金
安徽省卫计委中医药项目(2016-zy106)
阜阳市第六批创新团队项目
关键词
膜性肾病
环孢素A
环磷酰胺
疗效
Membranous nephropathy
Cyclosporines
Cyclophosphamide
Efficacy
