中国实用医刊
中國實用醫刊
중국실용의간
CENTRAL PLAINS MEDICAL JOURNAL
2013年
5期
36-39
,共4页
特发性膜性肾病%环孢素A%雷公藤多苷%激素
特髮性膜性腎病%環孢素A%雷公籐多苷%激素
특발성막성신병%배포소A%뢰공등다감%격소
Idiopathic membranous nephropathy%Cyclosporin A%Tripterygium wilfordii%Steroid
目的 观察多种免疫抑制剂联合治疗特发性膜性肾病(IMN)的疗效及安全性.方法 31例患者均符合原发性肾病综合征诊断标准,肾活检病理结果为IMN,尿蛋白定量≥3.5 g/24h,血浆白蛋白＜30 g/L.所有患者随机分组,多靶点组15例,环磷酰胺组(CTX) 16例；多靶点组患者均接受小剂量环孢素A(CsA)2 mg/(kg·d)和雷公藤多甙(60 mg/d),联合中等剂量的强的松0.5 mg/(kg·d)治疗,12周后强的松每2周减5 mg,20 mg以下每2周减2.5 mg,10 mg维持；CsA 24周后减半量维持；雷公藤多甙24周后减半量维持.对照组予强的松0.8～1.0 mg/kg+环磷酰胺(CTX)冲击治疗,CTX首次剂量0.75 g/m2,此后可根据具体情况调整在0.5 ～1.0 g/m2,每月1次；CTX总量为6～8g.在治疗后第2、4、6、8、12、24、48周动态监测血压、24h尿蛋白定量、血常规、血清白蛋白、肌酐、尿素氮、血糖、胆固醇、天门冬氨酸氨基转移酶、丙氨酶氨基转移酶等各项临床指标,同时记录不良反应.结果 多靶点组在治疗2周后患者的24 h尿蛋白定量已较治疗前有明显减少(P＜0.01),血清白蛋白在治疗后的第4周开始明显升高(P＜ 0.01).胆固醇在治疗后的第4周开始下降(P＜0.05),第8周开始明显下降(P＜0.01).CTX组在治疗8周后患者的24h尿蛋白定量已较治疗前明显减少(P＜0.01),血清白蛋白有明显升高(P＜0.01).胆固醇在治疗后的第8周开始下降(P＜0.05),第12周开始明显下降(P＜ 0.01).多靶点组治疗48周后完全缓解3例(20.0％),部分缓解10例(66.67％),总缓解率为86.67％.CTX组治疗48周后完全缓解4例(25.0％),部分缓解9例(56.25％),总缓解率为81.25％.两组总缓解率比较差异无统计学意义.两组患者在治疗过程中均未出现严重不良反应.结论 多靶点治疗特发性膜性肾病与CTX相比,治疗48周的总体疗效相当,但多靶点组起效更快,不良反应少,安全性较高.
目的 觀察多種免疫抑製劑聯閤治療特髮性膜性腎病(IMN)的療效及安全性.方法 31例患者均符閤原髮性腎病綜閤徵診斷標準,腎活檢病理結果為IMN,尿蛋白定量≥3.5 g/24h,血漿白蛋白＜30 g/L.所有患者隨機分組,多靶點組15例,環燐酰胺組(CTX) 16例；多靶點組患者均接受小劑量環孢素A(CsA)2 mg/(kg·d)和雷公籐多甙(60 mg/d),聯閤中等劑量的彊的鬆0.5 mg/(kg·d)治療,12週後彊的鬆每2週減5 mg,20 mg以下每2週減2.5 mg,10 mg維持；CsA 24週後減半量維持；雷公籐多甙24週後減半量維持.對照組予彊的鬆0.8～1.0 mg/kg+環燐酰胺(CTX)遲擊治療,CTX首次劑量0.75 g/m2,此後可根據具體情況調整在0.5 ～1.0 g/m2,每月1次；CTX總量為6～8g.在治療後第2、4、6、8、12、24、48週動態鑑測血壓、24h尿蛋白定量、血常規、血清白蛋白、肌酐、尿素氮、血糖、膽固醇、天門鼕氨痠氨基轉移酶、丙氨酶氨基轉移酶等各項臨床指標,同時記錄不良反應.結果 多靶點組在治療2週後患者的24 h尿蛋白定量已較治療前有明顯減少(P＜0.01),血清白蛋白在治療後的第4週開始明顯升高(P＜ 0.01).膽固醇在治療後的第4週開始下降(P＜0.05),第8週開始明顯下降(P＜0.01).CTX組在治療8週後患者的24h尿蛋白定量已較治療前明顯減少(P＜0.01),血清白蛋白有明顯升高(P＜0.01).膽固醇在治療後的第8週開始下降(P＜0.05),第12週開始明顯下降(P＜ 0.01).多靶點組治療48週後完全緩解3例(20.0％),部分緩解10例(66.67％),總緩解率為86.67％.CTX組治療48週後完全緩解4例(25.0％),部分緩解9例(56.25％),總緩解率為81.25％.兩組總緩解率比較差異無統計學意義.兩組患者在治療過程中均未齣現嚴重不良反應.結論 多靶點治療特髮性膜性腎病與CTX相比,治療48週的總體療效相噹,但多靶點組起效更快,不良反應少,安全性較高.
목적 관찰다충면역억제제연합치료특발성막성신병(IMN)적료효급안전성.방법 31례환자균부합원발성신병종합정진단표준,신활검병리결과위IMN,뇨단백정량≥3.5 g/24h,혈장백단백＜30 g/L.소유환자수궤분조,다파점조15례,배린선알조(CTX) 16례；다파점조환자균접수소제량배포소A(CsA)2 mg/(kg·d)화뢰공등다대(60 mg/d),연합중등제량적강적송0.5 mg/(kg·d)치료,12주후강적송매2주감5 mg,20 mg이하매2주감2.5 mg,10 mg유지；CsA 24주후감반량유지；뢰공등다대24주후감반량유지.대조조여강적송0.8～1.0 mg/kg+배린선알(CTX)충격치료,CTX수차제량0.75 g/m2,차후가근거구체정황조정재0.5 ～1.0 g/m2,매월1차；CTX총량위6～8g.재치료후제2、4、6、8、12、24、48주동태감측혈압、24h뇨단백정량、혈상규、혈청백단백、기항、뇨소담、혈당、담고순、천문동안산안기전이매、병안매안기전이매등각항림상지표,동시기록불량반응.결과 다파점조재치료2주후환자적24 h뇨단백정량이교치료전유명현감소(P＜0.01),혈청백단백재치료후적제4주개시명현승고(P＜ 0.01).담고순재치료후적제4주개시하강(P＜0.05),제8주개시명현하강(P＜0.01).CTX조재치료8주후환자적24h뇨단백정량이교치료전명현감소(P＜0.01),혈청백단백유명현승고(P＜0.01).담고순재치료후적제8주개시하강(P＜0.05),제12주개시명현하강(P＜ 0.01).다파점조치료48주후완전완해3례(20.0％),부분완해10례(66.67％),총완해솔위86.67％.CTX조치료48주후완전완해4례(25.0％),부분완해9례(56.25％),총완해솔위81.25％.량조총완해솔비교차이무통계학의의.량조환자재치료과정중균미출현엄중불량반응.결론 다파점치료특발성막성신병여CTX상비,치료48주적총체료효상당,단다파점조기효경쾌,불량반응소,안전성교고.
Objective To evaluate the therapeutic efficacy of cyclosporin A,tripterygium wilfordii(TW) combined with steroid idiopathic membranous nephropathy(IMN).Methods Thirty-one cases were enrolled in this trial with primary nephrotic syndrome,renal biopsy for IMN pathology,proteinuria ≥ 3.5 g/24 h,serum albumin ＜ 30 g/L.All of the patients were randomized divided into two groups,the multi-target group enrolled 15 cases,the other 16 cases were in the cyclophosphamide group(CTX).The patients in multi-target group received small doses cyclosporine A (CsA) [dose for 2 mg/(kg · d)] and tripterygium wilfordii(TW) (60 mg/d),and moderate doses of prednisone(P) [0.5 mg/(kg · d)] for 12 weeks with taper doses of 10 mg maintain.CsA was given at 2 mg/(kg · d) for 24 weeks,then 1 mg/(kg · d) sustained.TW was given at 60 mg/d for 24 weeks,then 30 mg/d sustained.The CTX group accepted prednisone 0.8-1.0 mg/kg and cyclophosphamide (CTX),CTX began at 0.75 g/m2,then can be adjusted according to the specific conditions in 0.5-1.0 g/m2,monthly 1 time.Total CTX were 6-8 g.The adverse reactions and concerned efficacies including blood pressure,proteinuria of 24 h,routine blood,serum albumin,urea nitrogen,serum creatinine,blood sugar and cholesterol,aspertate aminotransferase,cereal third transaminase etc.were observed in the period of 2,4,6,8,12,24,48 weeks after treatment.Results In the multi-target group,after two weeks' therapy,proteinuria of 24 h decereased significantly (P ＜ 0.01),after four weeks' therapy,serum albumin improved significantly (P ＜ 0.01).Cholesterol in the fourth weeks after treatment began to drop (P ＜ 0.05),declined obviously at the 8th week (P ＜ 0.01).In the CTX group,after four weeks' therapy,proteinuria of 24 h was significantly reduced (P ＜ 0.01),serum albumin had increased significantly (P ＜0.01).Cholesterol in the 8th week after treatment began to drop (P ＜ 0.05),at it declined obviously after 12 weeks (P ＜ 0.01).Mter 48 weeks' treatment,the remission rate were 86.67％ in the multi-target group but 81.25％ in the CTX group.The complete remission rate was 20.0％ in the multi-target group but 25％ in the CTX group.The remission rate was not significantly different between the two groups (P ＞0.05).There was no severe adverse event during the course of treatment.Conclusions Forty-eight weeks in the treatment of IMN,multi-target compared with CTX in the total curative effect quite,but multiple target group effect faster,less adverse reaction and high safety.
