CAJ | 학술논문

目的：对比观察环孢素A（CsA）与环磷酰胺（CTX）联合激素治疗特发性膜性肾病的疗效与安全性。方法选取门诊长期随访的经肾活检确诊的特发性膜性肾病患者40例，随机分为CsA组与CTX组各20例，分别给予CsA联合糖皮质激素，CTX联合糖皮质激素治疗，疗程12个月。观察各组治疗前后尿蛋白定量、血浆白蛋白、血脂、肝、肾功能、血白细胞总数变化及其他不良反应，及两组患者治疗前后的缓解率。结果治疗3、6个月末CsA组的尿蛋白定量、胆固醇水平显著低于CTX组（P＜0.05），血浆白蛋白显著高于CTX组（P＜0.05），而6个月末时CTX组的血白细胞水平显著低于CsA组（P＜0.05），两组的ALT、SCr比较差异无统计学意义（P＞0.05）。治疗3个月末及6个月末CsA组的缓解率显著高于CTX组（x2=5.11，P＜0.05；x2=4.26，P＜0.05）。治疗12个月末两组的缓解率差异无统计学意义（x2=0.11，P＞0.05）。结论与CTX比较，CsA联合激素治疗IMN总体疗效相当，但CsA起效更快，近期疗效更好，不良反应更小。
목적：대비관찰배포소A（CsA）여배린선알（CTX）연합격소치료특발성막성신병적료효여안전성。방법선취문진장기수방적경신활검학진적특발성막성신병환자40례，수궤분위CsA조여CTX조각20례，분별급여CsA연합당피질격소，CTX연합당피질격소치료，료정12개월。관찰각조치료전후뇨단백정량、혈장백단백、혈지、간、신공능、혈백세포총수변화급기타불량반응，급량조환자치료전후적완해솔。결과치료3、6개월말CsA조적뇨단백정량、담고순수평현저저우CTX조（P＜0.05），혈장백단백현저고우CTX조（P＜0.05），이6개월말시CTX조적혈백세포수평현저저우CsA조（P＜0.05），량조적ALT、SCr비교차이무통계학의의（P＞0.05）。치료3개월말급6개월말CsA조적완해솔현저고우CTX조（x2=5.11，P＜0.05；x2=4.26，P＜0.05）。치료12개월말량조적완해솔차이무통계학의의（x2=0.11，P＞0.05）。결론여CTX비교，CsA연합격소치료IMN총체료효상당，단CsA기효경쾌，근기료효경호，불량반응경소。
Objective To observe comparatively the efficacy and safety of cyclosporine A (CsA) and cyclophosphamide(CTX) combined hormone in the treatment of idiopathic membranous nephropathy(IMN).Methods40 outpatients who were followed-up for a long time with idiopathic membranous nephropathy(IMN) confirmed by biopsy were randomLy divided into two groups: CsA group and CTX group. Treatments were given respectively CsA combined with glucocorticoids, CTX combined with glucocorticoids for 12 months. To observe changes in 24h urinary protein,serum albumin,serum cholesterol, liver function,kidney function, blood leukocytes,other adverse reactions, and remission rates before and after treatment in each group.ResultsThe 24h urine protein and serum cholesterol of CsA group were lower significantly than CTX group after treatment for 3 months and 6months(P<0.05),serum albumin was higher significantly than CTX group(P<0.05),while the leukocyte of CTX group was lower significantly than CsA group after treatment for 6 months(P<0.05),The ALT and SCr of two groups has no significant difference(P>0.05). The remission rate of CsA group was higher significantly than CTX group after treatment for 3 months and 6months (x2 =5.11,P<0.05;x2 = 4.26,P<0.05),There was no significant difference in remission rate in both groups after treatment for12 months(x2 =0.11,P>0.05).Conclusion Compared with CTX, CsA combined with hormone has equivalent efficacy in treatment for the IMN, but CsA has faster onset, better curative effect, less adverse reactions than CTX.