中华肾病研究电子杂志
中華腎病研究電子雜誌
중화신병연구전자잡지
2013年
6期
315-319
,共5页
边琪%李娟%于光%孙婧%郭志勇
邊琪%李娟%于光%孫婧%郭誌勇
변기%리연%우광%손청%곽지용
特发性膜性肾病%丙种球蛋白%治疗
特髮性膜性腎病%丙種毬蛋白%治療
특발성막성신병%병충구단백%치료
Idiopathic membranous nephropathy%Gamma globulin%Treatment
目的：研究丙种球蛋白冲击联合糖皮质激素和环磷酰胺（CTX）治疗表现为肾病综合征的特发性膜性肾病（IMN）的有效性和安全性。方法回顾性分析第二军医大学附属长海医院肾内科2008年7月至2012年6月，尿蛋白＞3．5 g/24 h，经肾活检并结合临床诊断为IMN患者临床资料。初始治疗采用丙种球蛋白冲击[0．4 g/（kg·d）×3 d]继之给予足量泼尼松[1 mg/（kg·d），最大剂量80 mg/d，联合CTX （0．75 g/m2体表面积，1次/月，共6次）冲击治疗，足量泼尼松治疗2个月后规律减量，入组为丙球组，共19例；按照年龄、性别及尿蛋白程度匹配的方式，入组同期诊断为IMN 单纯采用糖皮质激素联合CTX（用法与丙球组相同）的患者19例，设为对照组。总疗程均为6个月。观察两组治疗6个月后的疗效及不良反应。组间计量资料比较采用t检验，组间计数资料比较采用卡方检验。治疗随访结果以部分缓解为观察终点，以Kaplan-Meier生存曲线表示。结果治疗6个月时，丙球组4例（4/19，21．1％）患者完全缓解，9例（9/19，47．4％）患者部分缓解，有效率为68．5％（13/19）；对照组3例（3/19，15．8％）患者完全缓解，8例（8/19，42．1％）患者部分缓解，有效率为57．9％（11/19）。丙球组达到部分缓解的平均时间较对照组短[（2．54±1．39）月与（3．73±1．50）月]，差异有统计学意义（P＜0．05）。两组患者在治疗过程均未发生严重不良反应，丙球组感染的发生率低于对照组，差异有统计学意义（P＜0．05）。结论丙种球蛋白联合糖皮质激素和环磷酰胺治疗特发性膜性肾病大多能有效减轻蛋白尿，感染并发症少。
目的：研究丙種毬蛋白遲擊聯閤糖皮質激素和環燐酰胺（CTX）治療錶現為腎病綜閤徵的特髮性膜性腎病（IMN）的有效性和安全性。方法迴顧性分析第二軍醫大學附屬長海醫院腎內科2008年7月至2012年6月，尿蛋白＞3．5 g/24 h，經腎活檢併結閤臨床診斷為IMN患者臨床資料。初始治療採用丙種毬蛋白遲擊[0．4 g/（kg·d）×3 d]繼之給予足量潑尼鬆[1 mg/（kg·d），最大劑量80 mg/d，聯閤CTX （0．75 g/m2體錶麵積，1次/月，共6次）遲擊治療，足量潑尼鬆治療2箇月後規律減量，入組為丙毬組，共19例；按照年齡、性彆及尿蛋白程度匹配的方式，入組同期診斷為IMN 單純採用糖皮質激素聯閤CTX（用法與丙毬組相同）的患者19例，設為對照組。總療程均為6箇月。觀察兩組治療6箇月後的療效及不良反應。組間計量資料比較採用t檢驗，組間計數資料比較採用卡方檢驗。治療隨訪結果以部分緩解為觀察終點，以Kaplan-Meier生存麯線錶示。結果治療6箇月時，丙毬組4例（4/19，21．1％）患者完全緩解，9例（9/19，47．4％）患者部分緩解，有效率為68．5％（13/19）；對照組3例（3/19，15．8％）患者完全緩解，8例（8/19，42．1％）患者部分緩解，有效率為57．9％（11/19）。丙毬組達到部分緩解的平均時間較對照組短[（2．54±1．39）月與（3．73±1．50）月]，差異有統計學意義（P＜0．05）。兩組患者在治療過程均未髮生嚴重不良反應，丙毬組感染的髮生率低于對照組，差異有統計學意義（P＜0．05）。結論丙種毬蛋白聯閤糖皮質激素和環燐酰胺治療特髮性膜性腎病大多能有效減輕蛋白尿，感染併髮癥少。
목적：연구병충구단백충격연합당피질격소화배린선알（CTX）치료표현위신병종합정적특발성막성신병（IMN）적유효성화안전성。방법회고성분석제이군의대학부속장해의원신내과2008년7월지2012년6월，뇨단백＞3．5 g/24 h，경신활검병결합림상진단위IMN환자림상자료。초시치료채용병충구단백충격[0．4 g/（kg·d）×3 d]계지급여족량발니송[1 mg/（kg·d），최대제량80 mg/d，연합CTX （0．75 g/m2체표면적，1차/월，공6차）충격치료，족량발니송치료2개월후규률감량，입조위병구조，공19례；안조년령、성별급뇨단백정도필배적방식，입조동기진단위IMN 단순채용당피질격소연합CTX（용법여병구조상동）적환자19례，설위대조조。총료정균위6개월。관찰량조치료6개월후적료효급불량반응。조간계량자료비교채용t검험，조간계수자료비교채용잡방검험。치료수방결과이부분완해위관찰종점，이Kaplan-Meier생존곡선표시。결과치료6개월시，병구조4례（4/19，21．1％）환자완전완해，9례（9/19，47．4％）환자부분완해，유효솔위68．5％（13/19）；대조조3례（3/19，15．8％）환자완전완해，8례（8/19，42．1％）환자부분완해，유효솔위57．9％（11/19）。병구조체도부분완해적평균시간교대조조단[（2．54±1．39）월여（3．73±1．50）월]，차이유통계학의의（P＜0．05）。량조환자재치료과정균미발생엄중불량반응，병구조감염적발생솔저우대조조，차이유통계학의의（P＜0．05）。결론병충구단백연합당피질격소화배린선알치료특발성막성신병대다능유효감경단백뇨，감염병발증소。
Objective A clinical control study was conducted to evaluate the efficacy and safety of gamma globulin pulse therapy combined with steroids and cyclophosphamide (CTX ) in idiopathic membranous nephropathy (IMN ) patients manifesting as nephrotic syndrome.Methods IMN patients retrospectively collected in our hospital from July 2008 to June 2012,were diagnosed according to urinary protein over 3.5 g/24 h,renal biopsy,and clinical features.The initial treatment was pulse gamma globulin [0.4 g /(kg·d) ×3 d]followed by enough prednisone [1 mg/(kg·d),maximum dose 80 mg/d]plus pulse CTX (0.75 g/m2 BSA,1 time /month ×6 times ).After 2 months of enough dose therapy, prednisone was regularly reduced.These patients entered the gamma globulin group of 19 cases.the The control group also contained nineteen IMN patients matched by age,gender,and urinary protein level,who were treated with only oral prednisone plus pulse CTX.The whole course of treatment lasted 6 months in each group,and then the efficacy and safety were evaluated.The test data were analyzed with SPSS 16.0 statistical software.As for quantitative data expressed as mean ±standard deviation,differences between the two groups were compared with t test,while for count data expressed as number of cases (percentage), differences between the two groups were compared with the chi-square test.The endpoint result of follow-up after treatment was partial remission,which was expressed with Kaplan-Meier survival curve,and differences between the two groups were compared with log-rank test.A difference was considered statistically significant when P value was less than 0.05.Results After 6 months of treatment,the gamma globulin group showed complete remission in 4 cases (4/19,21.1%),and partial remission in 9 cases (9/19,47.4%),with an effective rate of 68.5% (13/19),while the control group showed complete remission in 3 cases (3/19, 15.8%),and partial remission in 8 cases (8/19,42.1%),with an effective rate of57.9%(11/19).The gamma globulin group achieved the partial remission in an average time less than the control group [(2.54 ±1.39)months vs (3.73 ±1.50)months],which was statistically significant (χ2 =4.378,P<0.05 ).No severe adverse events were observed during the treatment.The incidence of infection was significantly lower in gamma globulin group than in control group (χ2 =4.378,P<0.05 ).Conclusions The treatment of gamma globulin therapy combined with steroids and CTX was effective in reducing proteinuria of most IMN patients,and was with few infectious complications.
