中国基层医药
中國基層醫藥
중국기층의약
CHINESE JOURNAL OF PRIMARY MEDICINE AND PHARMACY
2015年
16期
2467-2469,2470
,共4页
膜性肾病%环孢素%泼尼松%安全性
膜性腎病%環孢素%潑尼鬆%安全性
막성신병%배포소%발니송%안전성
Membranous nephropathy%Cyclosporin%Prednisone%Safety
目的:观察环孢素联合泼尼松治疗膜性肾病的临床疗效及安全性,为临床治疗提供新选择。方法将符合入组标准的84例特发性膜性肾病患者按数字表法随机分为观察组和对照组,每组各42例;对照组给予环磷酰胺(CTX)联合泼尼松治疗;观察组给予环孢素联合泼尼松治疗,两组患者均治疗12个月,治疗前、治疗3个月、6个月、9个月、12个月后比较两组患者24 h 尿蛋白、血清白蛋白、肌酐、丙氨酸氨基转移酶;所有患者均随访2年,评价两组近期临床疗效并对比疗效差异性,统计随访2年累计复发率,记录不良反应发生情况。结果对照组和观察组治疗后3个月、6个月、9个月、12个月的24 h 尿蛋白分别为(5.6±2.6)g 和(4.0±2.1)g,(4.0±2.2)g 和(3.2±1.6)g,(3.8±1.4)g 和(3.0±1.5)g,(3.1±1.6)g 和(3.0±1.4)g,较治疗前明显降低(F =4.513和6.443)(均 P <0.05);血清白蛋白分别为(24.5±7.8)g/L 和(25.8±3.2)g/L,(26.2±6.4)g/L 和(31.1±9.4)g/L,(28.6±8.8)g/L 和(33.2±10.0)g/L,(33.6±9.4)g/L 和(35.8±9.8)g/L,均较治疗前明显升高(F =5.319和7.221,均 P <0.05);观察组治疗后3个月、6个月、9个月24 h 尿蛋白明显低于对照组(t =3.737、3.334、3.915,均 P <0.05);血清白蛋白明显高于对照组(t =3.356、3.832、3.774,均 P <0.05)。观察组和对照组治疗后3个月、6个月、9个月的临床疗效分别为48.24%和26.19%,85.71%和69.05%,88.10%和73.81%(χ2=6.652、5.977、7.239,均 P <0.05)。观察组和对照组治疗后1年、2年的累积复发率差异无统计学意义(均 P >0.05);观察组和对照组的不良反应发生率分别为30.95%和11.91%(χ2=4.592,P <0.05)。结论环孢素能够有效降低膜性肾病患者蛋白尿,提高血清白蛋白,且起效速度快,近期疗效更高,虽然不良反应有所增加,但易于监测和控制,对于 CTX 治疗无效或复发的患者可考虑使用。
目的:觀察環孢素聯閤潑尼鬆治療膜性腎病的臨床療效及安全性,為臨床治療提供新選擇。方法將符閤入組標準的84例特髮性膜性腎病患者按數字錶法隨機分為觀察組和對照組,每組各42例;對照組給予環燐酰胺(CTX)聯閤潑尼鬆治療;觀察組給予環孢素聯閤潑尼鬆治療,兩組患者均治療12箇月,治療前、治療3箇月、6箇月、9箇月、12箇月後比較兩組患者24 h 尿蛋白、血清白蛋白、肌酐、丙氨痠氨基轉移酶;所有患者均隨訪2年,評價兩組近期臨床療效併對比療效差異性,統計隨訪2年纍計複髮率,記錄不良反應髮生情況。結果對照組和觀察組治療後3箇月、6箇月、9箇月、12箇月的24 h 尿蛋白分彆為(5.6±2.6)g 和(4.0±2.1)g,(4.0±2.2)g 和(3.2±1.6)g,(3.8±1.4)g 和(3.0±1.5)g,(3.1±1.6)g 和(3.0±1.4)g,較治療前明顯降低(F =4.513和6.443)(均 P <0.05);血清白蛋白分彆為(24.5±7.8)g/L 和(25.8±3.2)g/L,(26.2±6.4)g/L 和(31.1±9.4)g/L,(28.6±8.8)g/L 和(33.2±10.0)g/L,(33.6±9.4)g/L 和(35.8±9.8)g/L,均較治療前明顯升高(F =5.319和7.221,均 P <0.05);觀察組治療後3箇月、6箇月、9箇月24 h 尿蛋白明顯低于對照組(t =3.737、3.334、3.915,均 P <0.05);血清白蛋白明顯高于對照組(t =3.356、3.832、3.774,均 P <0.05)。觀察組和對照組治療後3箇月、6箇月、9箇月的臨床療效分彆為48.24%和26.19%,85.71%和69.05%,88.10%和73.81%(χ2=6.652、5.977、7.239,均 P <0.05)。觀察組和對照組治療後1年、2年的纍積複髮率差異無統計學意義(均 P >0.05);觀察組和對照組的不良反應髮生率分彆為30.95%和11.91%(χ2=4.592,P <0.05)。結論環孢素能夠有效降低膜性腎病患者蛋白尿,提高血清白蛋白,且起效速度快,近期療效更高,雖然不良反應有所增加,但易于鑑測和控製,對于 CTX 治療無效或複髮的患者可攷慮使用。
목적:관찰배포소연합발니송치료막성신병적림상료효급안전성,위림상치료제공신선택。방법장부합입조표준적84례특발성막성신병환자안수자표법수궤분위관찰조화대조조,매조각42례;대조조급여배린선알(CTX)연합발니송치료;관찰조급여배포소연합발니송치료,량조환자균치료12개월,치료전、치료3개월、6개월、9개월、12개월후비교량조환자24 h 뇨단백、혈청백단백、기항、병안산안기전이매;소유환자균수방2년,평개량조근기림상료효병대비료효차이성,통계수방2년루계복발솔,기록불량반응발생정황。결과대조조화관찰조치료후3개월、6개월、9개월、12개월적24 h 뇨단백분별위(5.6±2.6)g 화(4.0±2.1)g,(4.0±2.2)g 화(3.2±1.6)g,(3.8±1.4)g 화(3.0±1.5)g,(3.1±1.6)g 화(3.0±1.4)g,교치료전명현강저(F =4.513화6.443)(균 P <0.05);혈청백단백분별위(24.5±7.8)g/L 화(25.8±3.2)g/L,(26.2±6.4)g/L 화(31.1±9.4)g/L,(28.6±8.8)g/L 화(33.2±10.0)g/L,(33.6±9.4)g/L 화(35.8±9.8)g/L,균교치료전명현승고(F =5.319화7.221,균 P <0.05);관찰조치료후3개월、6개월、9개월24 h 뇨단백명현저우대조조(t =3.737、3.334、3.915,균 P <0.05);혈청백단백명현고우대조조(t =3.356、3.832、3.774,균 P <0.05)。관찰조화대조조치료후3개월、6개월、9개월적림상료효분별위48.24%화26.19%,85.71%화69.05%,88.10%화73.81%(χ2=6.652、5.977、7.239,균 P <0.05)。관찰조화대조조치료후1년、2년적루적복발솔차이무통계학의의(균 P >0.05);관찰조화대조조적불량반응발생솔분별위30.95%화11.91%(χ2=4.592,P <0.05)。결론배포소능구유효강저막성신병환자단백뇨,제고혈청백단백,차기효속도쾌,근기료효경고,수연불량반응유소증가,단역우감측화공제,대우 CTX 치료무효혹복발적환자가고필사용。
Objective To observe the clinical efficacy of cyclosporin and hormone in the treatment of patients with idiopathic membranous nephropathy,to provide a new choice for the clinical treatment.Methods 84 patients with idiopathic membranous nephropathy met the inclusion criteria were randomly divided into the observation group and control group,with 42 cases of each group.The control group was treated with cyclophosphamide (CTX)and prednisone,while the observation group was given cyclosporin and prednisone,both group had been treated for 12 months.Blood were exsanguinated for detecting 24h urine protein,serum albumin,creatinine,alanine aminotransferase before treatment and after treatment for 3 months,6 months,9 months and 12 months.All patients had been follow -up for 2 years for making a statistics of 2 -year cumulative recurrence rate,the short and long term clinical efficacy were compared and the adverse reactions were recorded.Results The 24h urine protein of the control group and observation group after 3 months,6 months,9 months and 12 months treatment were (5.6 ±2.6)g vs.(4.0 ±2.1)g, (4.0 ±2.2)g vs.(3.2 ±1.6)g,(3.8 ±1.4)g vs.(3.0 ±1.5)g,(3.1 ±1.6)g vs.(3.0 ±1.4)g,the observation group were significantly lower than before treatment (F =4.513 vs.6.443,all P <0.05).The serum albumin of the control group and observation group were (24.5 ±7.8)g/L vs.(25.8 ±3.2)g/L,(26.2 ±6.4)g/L vs.(31.1 ± 9.4)g/L,(28.6 ±8.8)g/L vs.(33.2 ±10.0)g/L,(33.6 ±9.4)g/L vs.(35.8 ±9.8)g/L,both group were signifi-cantly higher than before treatment (F =5.319 vs.7.221,all P <0.05).The 24h urine protein of the observation group were significantly lower than the control group,(t =3.737,3.334,3.915,all P <0.05).The serum albumin were significantly higher than the control group,(t =3.356,3.832,3.774,P <0.05.2).The clinical efficacy of the observation group and the control group after treatment for 3 months,6 months,9 months were 48.24% vs.26.19%,85.71% vs.69.05%,88.10% vs.73.81% (χ2 =6.652,5.977,7.239,all P <0.05.3),the cumulative recurrence rate after one year and two year had no difference between the two group,all P >0.05.The adverse reaction rates of the observation group and the control group were 30.95% vs.11.91%,χ2 =4.592,P <0.05.Conclusion Cyclos-porin can effectively reduce proteinuria and increased serum albumin faster,it has better short and long term clinical efficacy,the adverse reactions is easy to monitor and control although high,it can be considered for using because of invalid or relapse for CTX.