小剂量吗替麦考酚酯联合强的松对活动性狼疮性肾炎的长期疗效  

Low dose mycophenolate mofetil prevented a clinical relapse in patients with lupus nephritis

作　　者：刘少军[1] 陆福明[1] 

机构地区：[1]复旦大学附属华山医院肾脏科,上海200040

出　　处：《复旦学报（医学版）》2006年第4期537-540,共4页Fudan University Journal of Medical Sciences

摘　　要：目的观察新型免疫抑制剂吗替麦考酚酯（mycophenolate mofetil，MMF，骁悉）联合强的松对活动性狼疮性肾炎患者长期维持治疗的有效性及安全性。方法2002年12月-2004年1月,13例（男性3例-女性10例）经。肾活检证实为活动性狼疮性肾炎的患者入选接受MMF联合强的松进行诱导治疗．并在诱导治疗（24周）结束后继续维持期的治疗观察。诱导期MMF起始剂量为（1．46±0．13）g／d。强的松起始剂量为（35．2±10．6）g／d．并逐步减量。维持期MMF平均剂量为（0．6±0．3）g／d，强的松为（10．9±5．8）mg／d。平均观察时间为（69．2±18．8）周（48～92周）。结果治疗初肾脏病理Ⅲ型3例；Ⅳ型8例；Ⅴ＋Ⅳ型2例。急性指数（7．7±1．7）。慢性指数（1．3±0．9）。其中11例患者为肾病综合征。24周时12例患者获临床缓解（6例完全缓解．6例部分缓解）。在维持治疗期间，未观察到狼疮性肾炎和肾病综合征的复发。其余指标如Hb、SCr和免疫学指标如ANA等均维持明显改善状态。整个治疗期间，有3例患者肝酶增加，1例药物相关性血白细胞减少．1例带状疱疹，1例呼吸道感染，经积极治疗后均治愈。结论小剂量MMF联合强的松对活动性狼疮性肾炎患者维持期治疗能控制狼疮性。肾炎和肾病综合征的复发且安全性好。Purpose To determine the efficacy and safety of low dose mycophenolate mofetil （MMF） and prednisone in the induction and maintenance treatment of severe lupus nephritis. Methods Thirteen patients （3 males and 10 females） with lupus nephritis （ 3 in class Ⅲ, 8 in class Ⅳ, 2 in class Ⅴ ＋ Ⅳ） were treated with MMF and prednisone daily for 48-92 weeks （mean 69.2 ± 18.8 weeks）. Proteinuria, serum albumin, liver function, serological activity and complement were monitored monthly for the occurrence of a clinical relapse. The starting dose of MMF ranged from 1.0 g/d to 1.5 g/d. At the same time, the standard dose prednisone was given. During maintenance therapy, MMF dose was （0.6±0.3） g/d, prednisone dose was （10.9±5.8） mg/d. Results Eleven of 13 patients were nephrotic syndrome. Before the treatment, baseline activity index was 7.7 ± 1.7 and chronicity index was 1.3 ± 0.9. Complete remission was achieved in 6 patients and partial remission was achieved in 6 patients at 24 weeks. During maintenance therapy, no clinical relapse was occurred, and improvements in haemoglobin, serum creatinine, serum albumin were maintained. Side effects were minimal. Conclusions Low dose MMF in combination with prednisone showed strong efficacy in controlling the clinical relapse of lupus nephritis and nephrotic syndrome. And it was well tolerated.

关 键 词：吗替麦考酚酯 狼疮性肾炎 强的松 复发 

分 类 号：R692.3[医药卫生—泌尿科学]