多靶点治疗特发性膜性肾病的临床研究  

Treatment of idiopathic membranous nephropathy in patients with multitarget therapy

作　　者：高桂凤[1] 李玉平[1] 徐海燕[1] 

机构地区：[1]内蒙古自治区巴彦淖尔市医院肾内科,015000

出　　处：《中国实用医刊》2013年第5期36-39,共4页Chinese Journal of Practical Medicine

摘　　要：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≥3．5g/24h，血浆白蛋白〈30g／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）2mg／（kg·d）和雷公藤多甙（60mg／d），联合中等剂量的强的松0．5mg／（kg·d）治疗，12周后强的松每2周减5mg，20mg以下每2周减2．5mg，10mg维持；CsA24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0．8～1．0mg／kg＋环磷酰胺（CTX）冲击治疗，CTX首次剂量0．75g／m^2，此后可根据具体情况调整在0．5～1．0g／m^2，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24h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．O％），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�Objective To evaluate the therapeutic efficacy of cyclosporin A, tripterygium wilfordii （TW） combined with steroid idiopathic membranous nephropathy（1MN）. 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 muhi-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 tour 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 hwas significantly reduced albumin had increased （P 〈 0.01）, serum significantly （P 〈0. 01 ）. Cholesterol in the 8th week after treatment began to dr

关 键 词：特发性膜性肾病 环孢素A 雷公藤多苷 激素 

分 类 号：R692[医药卫生—泌尿科学]