糖皮质激素联合沙利度胺治疗难治性膜性肾病临床疗效观察  

Effect of glucocorticoid hormone and thalidomide combination therapy on membranous nephropathy

作　　者：刘秋菊[1] 侯淑芬[1] 傅雪建 张海松[1] 马家晴 刘占全[1] 

机构地区：[1]河北大学附属医院肾内科,河北保定071000 [2]河北大学附属医院心内科,河北保定071000

出　　处：《中日友好医院学报》2016年第2期87-89,92,共4页Journal of China-Japan Friendship Hospital

摘　　要：目的：研究糖皮质激素联合沙利度胺治疗病理为膜性肾病的难治性肾病综合征的临床疗效.方法：选择病理为膜性肾病的难治性肾病综合征患者30例,糖皮质激素＋沙利度胺50mg 2次/d,至尿蛋白转阴后再应用12周后减量为50mg,1次/d,维持半年停用.无效者最长服用24周停药.观察时间为24周.结果：24h尿蛋白从治疗前8.02±3.15降至1.41±1.89（P＜0.01）;血浆白蛋白从治疗前28.02±6.75升至36.77±3.91（P＜0.01）.大部分病例开始显效时间在8～16周,完全缓解29.62％,部分缓解51.85％,总有效率为81.48％.主要副作用为：皮疹、嗜睡乏力、头晕.无肝肾功能受损、骨髓抑制.结论：沙利度胺联合糖皮质激素治疗膜性肾病效果明显,副作用轻微,为肾病综合征难治性膜性肾病的治疗提供了一种新途径.Objective ：To study the clinical effect of glucocorticoid hormone and thalidomide combination ther- apy on membranous nephropathy with refractory nephrotic syndrome.Methods：Thirty patients with refractory nephrotic syndrome were studied.On the basis of glucocortieoid hormone,patients administered thalidomide 50 mg 2 times/day until urine protein turning into negative.These patients were given an additional 12 weeks and thalidomide dose was reduced to 50mg once daily and maintained 24 weeks.Twenty-four weeks combination therapy was used for those patients without effect.Results：Twenty four hours urinary protein reduced from 8.02~3.15 to 1.41~l.89（P〈0.01）.Plasma albumin increased from 28.02~6.75 to 36.77~3.91（P〈0.01）.Among 30 eases,29.62% shown complete response,51.85% shown partial response.Rash,sleepiness,fatigue and dizziness were major side effects.Conclusion：Thalidomide combination with glueoeorticoid hormone therapy was effective to refractory membranous nephropathy without severe side effect.

关 键 词：沙利度胺 肾病综合征 膜性肾病 

分 类 号：R692[医药卫生—泌尿科学]