CAJ | 학술논문

目的探讨不同剂量环磷酰胺(CTX)对弥漫增殖性狼疮肾炎各亚型的疗效差异.方法回顾性分析133例肾活检确诊的,接受糖皮质激素+CTX规律治疗的Ⅳ型(Ⅳ-G 和Ⅳ-S亚型)或Ⅳ+V型狼疮肾炎患者的基线Scr、尿蛋白量(24 h)、CTX剂量方案及预后情况.对各型各剂量组的预后情况进行比较.结果患者6个月内CTX平均累积剂量为(11.1±4.1)g.以6 g和12 g为界,将6个月时的CTX累积剂量分为高(>12 g)、中(>6～12g)、低(≤6 g)3个剂量组.与低剂量组比较,高剂量组Ⅳ+Ⅴ型、活动或慢性(A/C)患者完全缓解率有改善的趋势(Ⅳ+Ⅴ型:67%比40%,P=0.314;A/C:43%比0%,P=0.212),但未能明显改善Ⅳ-S和IV-G亚型的完全缓解率(Ⅳ-S亚型:67%比50%,P=0.548;Ⅳ-G亚型:65%比70%,P=0.560).高剂量组总不良反应高于低剂量组,但差异无统计学意义(51%比37%,P=0.224).结论激素+高剂量CTX的治疗方案可提高Ⅳ+Ⅴ型及慢性病变患者的缓解率.
목적 탐토불동제량배린선알(CTX)대미만증식성랑창신염각아형적료효차이.방법 회고성분석133례신활검학진적,접수당피질격소+CTX규률치료적Ⅳ형(Ⅳ-G 화Ⅳ-S아형)혹Ⅳ+V형랑창신염환자적기선Scr、뇨단백량(24 h)、CTX제량방안급예후정황.대각형각제량조적예후정황진행비교.결과 환자6개월내CTX평균루적제량위(11.1±4.1)g.이6 g화12 g위계,장6개월시적CTX루적제량분위고(>12 g)、중(>6～12g)、저(≤6 g)3개제량조.여저제량조비교,고제량조Ⅳ+Ⅴ형、활동혹만성(A/C)환자완전완해솔유개선적추세(Ⅳ+Ⅴ형:67%비40%,P=0.314;A/C:43%비0%,P=0.212),단미능명현개선Ⅳ-S화IV-G아형적완전완해솔(Ⅳ-S아형:67%비50%,P=0.548;Ⅳ-G아형:65%비70%,P=0.560).고제량조총불량반응고우저제량조,단차이무통계학의의(51%비37%,P=0.224).결론 격소+고제량CTX적치료방안가제고Ⅳ+Ⅴ형급만성병변환자적완해솔.
Objective To investigate the efficacy differences of different doses of cyclophosphamide(CTX)among subcategories of diffuse proliferative lupus nephritis(LN). Methods Clinical data of 133 LN patients diagnosed by renal biopsy with class IV or class IV +V who were treated with corticosteroid plus CTX were analyzed retrospectively. The baseline Scr, 24 h urine protein, CTX dosages and prognosis were compared among different dosages for each subcategory. Results The average cumulative dose of CTX within 6 months was(11.1 4.1)g. The high dose group was >12 g, the medium dose group was >6-12 g and the low dose group was ≤6 g. Compared to low dose group, high dose CTX increased the remission rate of class Ⅳ +Ⅴ(67% vs 40%, P=0.314)and chronic renal lesion(43% vs 0%, P=0.212), but such enhancement was not obvious in class Ⅳ(Ⅳ-S: 67% vs 50%, P=0.548, Ⅳ-G: 65% vs 70%, P= 0.560). Difference of overall adverse reactions was not significant between high dose group and low dose group(51% vs 37% ,P=0.224). Conclusion Corticosteroid plus high dose CTX may improve the remission rate of patients with class IV + V and chronic renal lesions.