不同治疗方案对特发性膜性肾病疗效的临床对照研究  

A controlled clinical study of efficacy of different treatment regimens for idiopathic membranous nephropathy

作　　者：罗曼宇[1] 刘丽华[1] 刘声茂[1] 张冬梅[1] LUO Man-yu;LIU Li-hua;LIU Sheng-mao;ZHANG Dong-mei(Department of Nephropathy,the Second Hospital of Jilin University,Changchun 130041,China)

机构地区：[1]吉林大学第二医院肾病内科

出　　处：《临床肾脏病杂志》2019年第11期798-802,共5页Journal Of Clinical Nephrology

基　　金：吉林省教育厅“十三五”科学技术项目(JJKH20190003KJ)

摘　　要：目的探讨比较激素(prednisone,Pre)联合环磷酰胺(cyclophosphamide,CTX)交替治疗方案(即改良Ponticelli方案,MPR方案)、激素联合CTX方案(Pre/CTX方案)和激素联合他克莫司(tacrolimus,TAC)方案(Pre/TAC方案)在治疗特发性膜性肾病(idiopathic membranous nephropathy,IMN)中的临床疗效及不良反应。方法回顾性分析67例于吉林大学第二医院接受肾活检诊断为IMN的患者的尿蛋白、白蛋白等临床资料,按治疗方案不同分为MPR组、Pre/CTX组和Pre/TAC组,所有患者均治疗6个月,观察3组患者治疗3个月和治疗6个月时的临床疗效,同时监测治疗过程中的不良反应。结果在治疗前,3组患者各指标无明显差异。治疗3个月时,MPR组23例患者中8例(34.7%)达部分缓解,有效率为34.7%;Pre/CTX组24例患者中有1例(4.2%)死亡,1例(4.2%)达完全缓解,8例(33.3%)达部分缓解,有效率为37.5%;Pre/TAC组20例患者中有8例(40.0%)达部分缓解,有效率为40.0%;3组有效率比较差异无统计学意义。治疗6个月时,MPR组患者死亡1例(4.3%),剩余22例患者中1例(4.3%)达完全缓解,12例(52.2%)达部分缓解,有效率为56.5%;Pre/CTX方案组剩余23例患者中有2例(8.7%)达完全缓解,17例(73.9%)达部分缓解,有效率为82.6%;Pre/TAC组20例患者中有1例(5.0%)达完全缓解,12例(60.0%)达部分缓解,有效率为65.0%;3组有效率比较差异无统计学意义。治疗过程中MPR组不良反应相对较少。结论MPR、Pre/CTX及Pre/TAC方案治疗IMN时总有效率相当;MPR方案具有疗程短和激素累积剂量少的特点,可能具有较高的安全性。Objective To evaluate the clinical efficacy and safety of the following different treatment regimens for idiopathic membranous nephropathy(IMN):modified Ponticelli regimen(MPR,alternating therapy of hormone(Prednisone,Pre)combined with Cyclophosphamide(CTX),prednisone combined with CTX(Pre/CTX)and prednisone combined with Tacrolimus(Pre/TAC).Methods A total of 67 patients diagnosed with IMN by kidney biopsy from the 2 nd Hospital of Jilin University were analyzed on their clinical information about urine protein and albumin.Based on the treatment regimens,they were divided into MPR group,Pre/CTX group and Pre/TAC group.All the patients were treated for 6 months.We observed clinical efficacy in the three groups for 3-month and 6-month treatment,and monitored adverse reactions during the treatment course.Results No significant difference was observed at baseline before treatment.After 3-month treatments,in the MPR group,8(34.7%)of 23 patients reached partly remission and the effectiveness rate is 34.7%;in the Pre/CTX group,1(4.2%)of 24 patients died,1(4.2%)reached complete remission,8(33.3%)reached partly remission and the effectiveness rate is 37.5%;and in the Pre/TAC group,8(40.0%)of 20 Pre/TAC group patients reached partly remission and the effective rate is 40.0%.The above results in the three groups have no statistical difference.After 6-months treatments,in the MPR group,1(4.3%)of 23 patients died,1(4.3%)of the rest 22 patients reached complete remission,12(52.2%)reached partly remission and the effectiveness rate is 56.5%;in the Pre/CTX group,2(8.7%)of the rest 23 patients reached complete remission,17(73.9%)reached partly remission and the effective rate is 82.6%;and in the Pre/TAC group,1 of 20 patients(5.0%)reached complete remission,12(60.0%)reached partly remission and the effective rate is 65.0%.The results in the 3 groups have no statistical difference.MPR had less adverse reactions during the treatments.Conclusions MPR,Pre/CTX and Pre/TAC regimens have comparable effectiveness for IMN;the MPR regimen

关 键 词：特发性膜性肾病 糖皮质激素 环磷酰胺 他克莫司 

分 类 号：R[医药卫生]