环磷酰胺联合糖皮质激素治疗特发性膜性肾病疗效的影响因素分析  

Predictive factors analysis of the efficacy of cyclophosphamide combined with glucocorticoids in the treatment of idiopathic membranous nephropathy

作　　者：贺红光[1] 黄亿芸 曾春[1] 吴潮清[1] 叶琨[1] 熊礼佳[1] 彭小梅[1] He Hongguang;Huang Yiyun;Zeng Chun;Wu Chaoqing;Ye Kun;Xiong Lijia;Peng Xiaomei(Department of Nephrology,the People's Hospital of Guangxi Zhuang Autonomous Region,Nanning 530000,China)

机构地区：[1]广西壮族自治区人民医院肾内科,南宁530000

出　　处：《中华肾脏病杂志》2019年第1期9-17,共9页Chinese Journal of Nephrology

基　　金：国家自然科学基金(81260121);广西卫生和计划生育委员会科研课题(Z2016267).

摘　　要：目的调查研究环磷酰胺(CTX)联合糖皮质激素治疗特发性膜性肾病(IMN)患者的疗效,并分析其影响因素,评估因CTX治疗效果不佳而调整用钙调磷酸酶抑制剂(CNI)后的疗效。方法采用回顾性队列研究的方法,入选2007年1月1日至2016年12月1日经广西壮族自治区人民医院肾脏科肾活检确诊的228例IMN患者为研究对象,所有入选者均接受CTX联合糖皮质激素治疗。二元Logistic多因素回归法分析患者首次治疗获临床缓解的基线临床病理预测因素。结果首次CTX联合糖皮质激素治疗228例IMN的总缓解例数(包括完全及部分缓解)为188例(82.5%),其中完全缓解(CR)141例(61.8%),CR的中位时间为8(6,12)个月,部分缓解(PR)的中位时间为3(1,4)个月。总体中位随访时间为25(13,43)个月。与缓解组比较,未缓解组患者血白蛋白水平较低,24 h尿蛋白量、血补体C3、C4水平较高,病理分期较轻(均P<0.05)。多因素Logistic回归分析结果提示,基线血白蛋白、补体C4水平及病理分期是IMN患者获临床缓解的独立预测因素。24例未缓解患者调整用CNI治疗,6个月总缓解率为66.7%(16/24),12个月总缓解率为77.3%(17/22)。结论基线血白蛋白、血补体C4水平及病理分期是CTX联合糖皮质激素治疗IMN患者获临床缓解的独立预测因素。CTX联合糖皮质激素治疗未获缓解患者调整CNI用药后仍能获得较高的缓解率。Objective To investigate the predictive factors affecting the efficacy of cyclophosphamide (CTX) combined with glucocorticoids in the treatment of idiopathic membranous nephropathy (IMN), and to evaluate the efficacy of calcineurin inhibitor (CNI) adjustment due to poor treatment.Methods A retrospective cohort study was conducted. Two hundreds and twenty-eight patients with IMN diagnosed by renal biopsy in the People's Hospital of Guangxi Zhuang Autonomous Region from January 1, 2007 to December 1, 2016 were enrolled. All subjects were treated with CTX in combination with glucocorticoids. The patients were divided into two groups: remission group and no remission group. Multivariable logistic regression analysis was used to determine the baseline clinical-pathological influencing factors for the remission of IMN in the enrolled patients.Results The number of total remission (including complete and partial remission) of the first CTX combined with glucocorticoid treatment in 228 patients with IMN was 188(82.5%). Among them, 141 patients (61.8%) had complete remission (CR), the median time for CR was 8(6, 12) months, and the median time for partial remission (PR) was 3(1, 4) months. The median follow-up time for this study was 25(13, 43) months. Compared with the remission group, the serum albumin level was lower in the non-remission group, the 24-hour urine protein content, the blood complement C3 and C4 levels were higher, and the pathological stage was milder (all P<0.05). Multivariate logistic regression analysis suggested that the levels of baseline serum albumin, complement C4, and pathological stage were independent predictors of clinical remission in IMN patients. Twenty-four non-remission patients were treated with CNI. The overall response rate was 66.7%(16/24) at 6 months and 77.3%(17/22) at 12 months.Conclusions The levels of baseline albumin, blood complement C4, and pathological stage were independent predictors of clinical remission in IMN patients treated with CTX plus glucocorticoids. The non-remis

关 键 词：肾小球肾炎 膜性 随访研究 预后 环磷酰胺 钙调磷酸酶抑制剂 

分 类 号：R692[医药卫生—泌尿科学]