霉酚酸酯治疗35例Ⅳ型狼疮性肾炎的长期随访  

Long-term follow-up study of diffuse prolifesative lupus nephritis treated with mycophenolate mofetil

作　　者：胡伟新[1] 刘志红[1] 唐政[1] 姚小丹[1] 王庆文[1] 沈克勤[1] 黎磊石[1] 

机构地区：[1]南京军区南京总医院解放军肾脏病研究所,南京210002

出　　处：《肾脏病与透析肾移植杂志》2001年第1期8-12,共5页Chinese Journal of Nephrology,Dialysis & Transplantation

摘　　要：目的 :回顾性总结霉酚酸酯 (MMF)治疗Ⅳ型狼疮性肾炎 (LN)的临床疗效 ,探讨MMF的剂量 ,了解复发情况。　 方法 :35例活动性LN患者 (其中 10例为初治 ,2 5例已经使用大剂量激素或联合间断环磷酰胺静脉冲击疗法 ) ,采用MMF联合激素治疗 6个月以上。所有患者治疗前尿蛋白 >2 0g/ 2 4h ,有明显血尿或管型尿 ,肾活检显示活动性Ⅳ型LN。MMF起始剂量 1 0～ 1 5g/d ,初治患者同时给予足量激素诱导治疗 ,对已经使用大剂量激素者继续口服中、小剂量强的松。疗效标准分为缓解、部分缓解及无效。在患者病情明显好转后MMF逐步减至 0 5～ 0 75g/d维持。　 结果 :①MMF治疗时间 6～ 36个月 (平均 12 7± 6 8月 )。在治疗期间共有 2 7例 (占 77 1% )获得缓解 (尿蛋白 <1 0g/d ,无活动性尿沉渣、肾功能稳定、血清A dsDNA阴性 ,无肾外活动 ) ,6例获部分缓解 ,2例无效。获得缓解的时间为 3～ 15个月 (平均 6 5± 4 7月 )。随着MMF治疗时间延长 ,缓解率逐步增高 :MMF治疗 3、6、12、2 4个月的缓解率分别为 2 5 7%、6 0 %、72 7%及 83 3%。 18例患者减量或停药前行重复肾活检 ,肾组织活动性指数显著下降。② 30例患者在治疗 3～ 6个月 ,临床获得缓解或部分缓解后开始减量。在MMF维持治疗 3～ 9个月间 12 5Objective:The clinical efficacy of mycophenolate mofetil(MMF)in the treatment of the patients with diffuse proliferative lupus nephritis(WHO type Ⅳ)was retrospectively analysed.The dose adjustment and relapse rate were evaluated. Methodology:Thirty five patients with lupus nephritis having proteinuria >2 0 g/d,showing active urinary sediment and the renal biopsy revealed type Ⅳ were treated with MMF and corticosteroid for more than 6 months.The starting dose of MMF ranged from 1 0 g/d to 1 5 g/d.The standard corticosteroid induction therapy was given for 10 newly diagnosed cases.Small to moderate doses of oral prednisone were prescribed for 25 patients being treated previously with large doses of steroids and intravenous cyclophosphamide therapy.Clinical efficacy was defined as remission,partial remission and being treated.Renal remission was evaluated as proteinuria <1 0 g/d,absence of active urinary sediments,improved or stable renal function,A negative dsDNA.The dose of MMF was gradually reduced to maintenance dose of 0 5～0 75 g/d after the patients achieved remission or partial remission. Results:The patients were treated with MMF for 6～36 months(mean 12 7±6 8 months),renal remission occurred in 27 of 35 patients(77 7%),6 patients achieved partial remission,2 patients were un response to MMF treatment.The time to remission after MMF treatment was 3～15 months(median 6 5±4 7 months).The estimated proportions entering into remission at 3 months,6 months,12 months and 24 months were 25 7%,60%,72 7% and 83 3% respectively.The dose of MMF was lowered in 30 patients who achieving remission or partial remission after MMF treatment for 3～6 months.12 5% of patients relapsed after MMF being reduced to maintenance dose for 3～9 months and 42 8% of case

关 键 词：狼疮性肾炎 霉酚酸酯 复发 治疗 

分 类 号：R593.242[医药卫生—内科学]