CAJ | 학술논문

目的：探讨单次小剂量间断环磷酰胺冲击治疗( cyclophosphamide pulse therapy,CPT)对成人难治性肾病综合征(RNS)的疗效,并观察环磷酰胺(CTX)的不良反应。方法成人RNS患者22例,开始每月予CTX 0．2g加入0．9%氯化钠溶液250mL,2h以上静脉滴注,隔日1次,连续3~4次,共3个月( CTX 1．8~2．4g)；以后每隔2月重复上述治疗,共6个月,总疗程9个月(CTX总量3．6~4．8g)。同时联合泼尼松0．5mg/(kg ·d)、抗凝及抗血小板等治疗,并在CPT治疗前后检查血常规、24h尿蛋白定量、肝、肾功能、全胸片及心电图,观察疗效及CTX不良反应。结果单次小剂量间断CPT 3个月后,22例患者中完全缓解(CR)5例(22．7%),部分缓解(PR)16例(72．7%),无效1例(4．5%)。9个月后, CR 19例(86．4%)、PR 2例(9．1%)、无效1例(4．5%),且缓解患者(PR +CR)较治疗前血白蛋白(ALB)上升(P <0．01),24h尿蛋白定量下降(P<0．01),血总胆固醇(CHO)也较治疗前下降(P<0．05),4例血肌酐(Scr)增高者恢复正常。治疗过程中未出现明显的CTX不良反应。结论单次小剂量间断CPT能提高成人RNS临床缓解率,且无明显的不良反应,值得推广。
목적：탐토단차소제량간단배린선알충격치료( cyclophosphamide pulse therapy,CPT)대성인난치성신병종합정(RNS)적료효,병관찰배린선알(CTX)적불량반응。방법성인RNS환자22례,개시매월여CTX 0．2g가입0．9%록화납용액250mL,2h이상정맥적주,격일1차,련속3~4차,공3개월( CTX 1．8~2．4g)；이후매격2월중복상술치료,공6개월,총료정9개월(CTX총량3．6~4．8g)。동시연합발니송0．5mg/(kg ·d)、항응급항혈소판등치료,병재CPT치료전후검사혈상규、24h뇨단백정량、간、신공능、전흉편급심전도,관찰료효급CTX불량반응。결과단차소제량간단CPT 3개월후,22례환자중완전완해(CR)5례(22．7%),부분완해(PR)16례(72．7%),무효1례(4．5%)。9개월후, CR 19례(86．4%)、PR 2례(9．1%)、무효1례(4．5%),차완해환자(PR +CR)교치료전혈백단백(ALB)상승(P <0．01),24h뇨단백정량하강(P<0．01),혈총담고순(CHO)야교치료전하강(P<0．05),4례혈기항(Scr)증고자회복정상。치료과정중미출현명현적CTX불량반응。결론단차소제량간단CPT능제고성인RNS림상완해솔,차무명현적불량반응,치득추엄。
Objective To explore the effect of a single low-dose of cyclophosphamide pulse therapy ( CPT) by intermit-tent infusion on adult refractory nephrotic syndrome ( RNS) and identify any features of cyclophosphamide ( CTX) toxicity. Meth-ods The study group consisted of 22 adult RNS hospitalized patients. They were treated 3 ~4 times per month at a single low-dose of CPT (0. 2g /qod) by intravenous infusion for 3 months (CTX 1. 8 ~2. 4g), then repeated it every 2 months for 6 months, total 9 months (CTX 3. 6~4. 8g). At the same time these patients were treated with prednisone 8 ~12weeks 0. 5mg/( kg ·d) , anticoagulant and antiplatelet therapy. Any adverse reactions of CTX were observed in these patients by examination. Results Complete remission (CR) was observed in 5 (22. 7%) and partial remission (PR) in 16 (72. 7%) patients after 3 months,one patient was invalid (4. 5% ). After 9 months of treatment CR was observed in 19 (86. 4%) and PR in 2 (9. 1%) patients, one patient was invalid (4. 5%), in remission patients (CR+PR) the level of serum albumin increased markedly (P<0. 01), proteinuria and cholesterol (CHO) were reduced significantly (P<0. 01; P<0. 05,respectively). The reduced renal function in 4 patients before treatment returned to normal. side-effects were minimal. Conclusion A single low-dose of CPT by intermittent infusion enhanced significant remission rate of adult RNS with minimal side-effects.