吗替麦考酚酯联合低剂量激素治疗HBsAg阳性的成人微小病变性肾病综合征  

Mycophenolate mofetil combined with low dose prednisone in the treatment for adults with minimal change nephrotic syndrome and concomitant HBsAg positive

作　　者：李夏玉[1] 田炯[1] 陈江华[1] 李恒[1] 何强[1] 林维勤[1] 倪勤[1] 贺学林[1] 吴建永[1] 

机构地区：[1]浙江大学医学院附属第一医院肾脏病中心,杭州310003

出　　处：《中华肾脏病杂志》2009年第1期14-17,共4页Chinese Journal of Nephrology

摘　　要：目的探讨吗替麦考酚酯（MMF）联合低剂量糖皮质激素方案治疗HBsAg阳性的成人微小病变性肾病综合征的疗效及安全性。方法前瞻性地选择HBsAg阳性、HBeAg阴性及血清HBV．DNA〈1000拷贝／ml的成人微小病变性肾病综合征患者30例，分成激素组（16例）及MMF组（14例）。激素组接受常规激素治疗方案（泼尼松片，1mg·kg^-1·d^-1）；MMF组接受低剂量激素（泼尼松片，0．5mg·kg^-1·d^-1）联合MMF1．0-2．0g／d。结果激素组和MMF组乙肝病毒激活发生比例分别为62．5％及35．7％，其中接受拉米呋定治疗分别为43．8％及21．4％；谷丙转氨酶升高发生比例分别为50．0％及28．6％。激素组及MMF组的完全缓解比例分别为11／14和10／12，两组复发比例分别为6／11和4／10。结论与常规激素治疗方案比较，MMF联合低剂量糖皮质激素方案能同样有效地治疗HBsAg阳性的成人微小病变性肾病综合征，并在减少乙肝病毒激活方面可能显示一定优势。Objective To assess the safety and efficacy of mycopheuolate mofetil （MMF） combined with low dose corticosteroid in the treatment of adults with minimal change nephrotic syndrome and concomitant HBsAg positive （MCNS-HBsAg）. Methods Thirty adults with MCNS-HBsAg were enrolled in this prospective study and were assigned to two groups. The Pred group （n=16） received conventional prednisone regimen （prednisone 1 mg·kg^-1·d^-1） and the MMF group （n=14） received low dose of prednisone combined with MMF （MMF 1.0 to 2.0 g/d plus prednisone 0.5 mg·kg^-1·d^-1）. Results Hepatitis B virus （HBV） was replicated in 62.5% patients of Pred group versus 35.7% patients of MMF group. 43.8% patients of Pred group versus 21.4% patients of MMF group received lamivudine therapy. Elevation of alanine aminotransferase （ALT） occurred in 50% patients of Pred group and 28.6% patients of MMF group. The complete remission （CR） rate after 24 weeks treatment was 11/14 in Pred group versus 10/12 in MMF group. 6/11 patients of the Pred group and 4/10 patients of the MMF group who achieved CR experienced relapses during follow-up. Conclusions Use of MMF combined with low dose prednisone is as effective as conventional prednisone regimen in treating adults with MCNS-HBsAg protocol seems to be superior in HBV reactivation to conventional prednisone protocol.

关 键 词：糖皮质激素类 肝炎病毒 乙型 肾病 脂性 肾病综合征 吗替麦考酚酯 

分 类 号：R692.3[医药卫生—泌尿科学]