中国医师进修杂志
中國醫師進脩雜誌
중국의사진수잡지
CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
2011年
31期
1-4
,共4页
蔡承敏%魏林%段志新%吴伟%宗海涛
蔡承敏%魏林%段誌新%吳偉%宗海濤
채승민%위림%단지신%오위%종해도
糖皮质激素类%拉米夫定%吗替麦考酚酯%乙型肝炎病毒相关性肾炎
糖皮質激素類%拉米伕定%嗎替麥攷酚酯%乙型肝炎病毒相關性腎炎
당피질격소류%랍미부정%마체맥고분지%을형간염병독상관성신염
Glucocorticoids%Lamivudine%Mycophenolate mofetil%Hepatitis B virus associated glomerulonephritis
目的 探讨吗替麦考酚酯、小剂量激素、拉米夫定联合治疗乙型肝炎病毒相关性肾炎的疗效.方法 回顾性总结病理确诊的49例乙型肝炎病毒相关性肾炎患者采用吗替麦考酚酯(≥12岁0.75 g,2次/d,＜12岁0.4 g/m2,2次/d)、拉米夫定(≥12岁100 mg/d,＜12岁3 mg/kg,2次/d)、小剂量激素[泼尼松0.5 mg/(kg·d)]的治疗方案.结果 49例患者中,完全缓解率71.4％(35/49),总有效率81.6％ (40/49),血清中的乙型肝炎病毒DNA平均值从5.43×104拷贝/ml降为＜ 1000拷贝/ml占85.7％(42/49).膜性肾病(MN)完全缓解率为88.0％(22/25),部分缓解率为8.0％(2/25),无效率为4.0％(1/25)；系膜增生性肾小球肾炎(MsPGN)完全缓解率为44.4％(4/9),无效率为55.6％( 5/9)；膜增殖性肾小球肾炎(MPGN)完全缓解率为70.0％(7/10),部分缓解率为30.0％(3/10)；局灶节段肾小球硬化(FSGS)完全缓解率为40.0％(2/5),无效率为60.0％( 3/5).不同病理类型疗效比较差异有统计学意义(P＜0.05).不良反应轻微.结论 吗替麦考酚酯、小剂量激素、拉米夫定联合治疗乙型肝炎病毒相关性肾炎安全有效,其疗效与病理类型有关,MN治疗反应最好,MPGN、MsPGN次之,FSGS较差.
目的 探討嗎替麥攷酚酯、小劑量激素、拉米伕定聯閤治療乙型肝炎病毒相關性腎炎的療效.方法 迴顧性總結病理確診的49例乙型肝炎病毒相關性腎炎患者採用嗎替麥攷酚酯(≥12歲0.75 g,2次/d,＜12歲0.4 g/m2,2次/d)、拉米伕定(≥12歲100 mg/d,＜12歲3 mg/kg,2次/d)、小劑量激素[潑尼鬆0.5 mg/(kg·d)]的治療方案.結果 49例患者中,完全緩解率71.4％(35/49),總有效率81.6％ (40/49),血清中的乙型肝炎病毒DNA平均值從5.43×104拷貝/ml降為＜ 1000拷貝/ml佔85.7％(42/49).膜性腎病(MN)完全緩解率為88.0％(22/25),部分緩解率為8.0％(2/25),無效率為4.0％(1/25)；繫膜增生性腎小毬腎炎(MsPGN)完全緩解率為44.4％(4/9),無效率為55.6％( 5/9)；膜增殖性腎小毬腎炎(MPGN)完全緩解率為70.0％(7/10),部分緩解率為30.0％(3/10)；跼竈節段腎小毬硬化(FSGS)完全緩解率為40.0％(2/5),無效率為60.0％( 3/5).不同病理類型療效比較差異有統計學意義(P＜0.05).不良反應輕微.結論 嗎替麥攷酚酯、小劑量激素、拉米伕定聯閤治療乙型肝炎病毒相關性腎炎安全有效,其療效與病理類型有關,MN治療反應最好,MPGN、MsPGN次之,FSGS較差.
목적 탐토마체맥고분지、소제량격소、랍미부정연합치료을형간염병독상관성신염적료효.방법 회고성총결병리학진적49례을형간염병독상관성신염환자채용마체맥고분지(≥12세0.75 g,2차/d,＜12세0.4 g/m2,2차/d)、랍미부정(≥12세100 mg/d,＜12세3 mg/kg,2차/d)、소제량격소[발니송0.5 mg/(kg·d)]적치료방안.결과 49례환자중,완전완해솔71.4％(35/49),총유효솔81.6％ (40/49),혈청중적을형간염병독DNA평균치종5.43×104고패/ml강위＜ 1000고패/ml점85.7％(42/49).막성신병(MN)완전완해솔위88.0％(22/25),부분완해솔위8.0％(2/25),무효솔위4.0％(1/25)；계막증생성신소구신염(MsPGN)완전완해솔위44.4％(4/9),무효솔위55.6％( 5/9)；막증식성신소구신염(MPGN)완전완해솔위70.0％(7/10),부분완해솔위30.0％(3/10)；국조절단신소구경화(FSGS)완전완해솔위40.0％(2/5),무효솔위60.0％( 3/5).불동병리류형료효비교차이유통계학의의(P＜0.05).불량반응경미.결론 마체맥고분지、소제량격소、랍미부정연합치료을형간염병독상관성신염안전유효,기료효여병리류형유관,MN치료반응최호,MPGN、MsPGN차지,FSGS교차.
Objective To assess the efficacy of mycophenolate mofetil (MMF) combined with low dose of hormone and lamivudine in the treatment of hepatitis B virus associated glomerulonephritis (HBV-GN).Methods The clinical data of 49 HBV-GN patients diagnosed by renal pathology was reviewed.They were treated with MMF( ≥ 12 years old,0.75 g,two times a day; ＜ 12 years old,0.4 g/m2,two times a day),low dose of hormone [0.5 mg/(kg·d) ],lamivudine( ≥ 12 years old,100 mg/d; ＜ 12 years old,3 mg/kg,two times a day).Results Among of 49 HBV-GN patients,clinical cure rate was 71.4％(35/49),the total effective rate was 81.6％(40/49),85.7％(42/49) patients' HBV DNA level decreased from 5.43 ×104 copies/ml to ＜ 1000 copies/ml.The complete remission rate was 88.0％ (22/25),the partial remission rate was 8.0％ (2/25),the inefficiency was 4.0％ (1/25) in membranous nephropathy (MN);the complete remission rate was 44.4％ (4/9),the inefficiency was 55.6％ (5/9) in mesangial proliferative glomerulone phritis (MsPGN) ; the complete remission rate was 70.0％(7/10); the partial remission rate was 30.0％(3/10)in membrane proliferative glomerulone phritis (MPGN) ;the complete remission rate was 40.0％ (2/5),the inefficiency was 60.0％(3/5) in focal segmental glomerulosclerosts (FSGS).There was significant difference among the different pathological type (P＜0.05).There were less adverse reactions.Conclusions MMF combined with low dose hormone and lamivudine is safe and effective in treating HBV-GN.The efficacy and pathological type has some relationship,MN has the best response,MPGN and MsPGN are second,FSGS is poor.
