皮质激素和间断环磷酰胺冲击治疗局灶节段性肾小球硬化疗效观察  

Efficacy of corticosteroids and pulse cyclophosphamide in adult nephrotic syndrome with focal segmental glomerulosclerosis

作　　者：陈晓农[1] 陈楠[1] 任红[1] 张文[1] 江永娣[1] 傅秀兰[1] 郝翠兰[1] 董德长[1] 

机构地区：[1]上海第二医科大学瑞金医院,200025

出　　处：《上海医学》2000年第9期563-566,共4页Shanghai Medical Journal

摘　　要：目的　观察激素及间断环磷酰胺 (CTX)冲击治疗局灶节段性肾小球硬化 肾病综合征 (FSGS NS)的疗效。方法　回顾性分析 1993～ 1997年间 ,6 3例FSGS NS患者对激素治疗的反应 ,疗效与病理的关系及随访结果。结果　以NS为表现的FSGS占同期肾活检FSGS的 43.45 % ,平均发病年龄 (31± 14)岁 ,男女之比为2 .15∶1,平均随访 43个月。对初始治疗有反应的患者 (Ⅰ组 )完全缓解率 (CR)高 ,为 6 5 .79% ,无进展至慢性肾功能衰竭 (CRF)者 ;对初始治疗无反应者 (Ⅱ组 )CR低 ,为 12 % ,延长激素及CTX治疗可使CR或部分缓解率(PR)增加至 48% ,进展至CRF者为 6 .35 %。治疗的反应及CR的高低与肾小球病变范围及肾小管间质病变严重程度有关 ,肾小球病变范围大 ,小管间质病变严重者 ,对初始治疗反应差 ,CR低。药物不良反应以感染和肝损为主。结论　延长皮质激素及间断CTX冲击治疗FSGS NS使NS的治疗缓解率增加 (总CR :44 .44 % ) ,进展至CRF少 (6 .35 % ) ,患者预后改善 ,临床上应根据肾脏病理 ,在严密监测药物不良反应的情况下 。Objective To observe the efficacy of corticosteroids and pulse cyclophosphamide in adult nephrotic syndrome(NS) with focal segmental glomerulosclerosis (FSGSZ).Method 63 hospitalized adult FSGS NS patients were included in this study between 1993 and 1997. Retrospective analysis of the therapeutic response, the relationship between efficacy and pathology and the outcome of the follow up were made.Results FSGS NS accounts for 43.45% of the total biospsied FSGS cases in the same period. The average age of these patients was (31.4±14) years. Male/Female=2.15∶1. They were followed up for (43.87±17.94) months. Among the 38 patientrs (60.3%) initially responsive to therapy, 65.8% obtained complete remission(CR) and none developed chronic renal failure(CRF); 25 patients originally resistant to therapy, only 12% had CR, prolonging steroids and cyclophosphamide therapy increased CR or partial remission(PR) to 48%, 6.35% developed CRF. The responsive rate to treatment was related with the degree of global and focal segmental sclerosis and tubulointerstitial damage. Compare to those initially responsive to therapy, in patients with no response to therapy originaly, the rate of global and focal segmental sclerosis and tubulointerstitial damage were usually more severe. The major side effects of the drug were infection and liver damage. Conclusions This study shows that prolonged treatment of FSGS NS with corticosteroids and pulse cyclophosphamide is effective in achieving sustained remission and improve prognosis in adults with FSGS NS. (Shanghai Med J, 2000,23∶563 566)

关 键 词：局灶节段肾小球硬化 皮质激素 环磷酰胺 

分 类 号：R692.6[医药卫生—泌尿科学]