环孢素联合糖皮质激素治疗特发性膜性肾病的临床研究  

Clinical Study of Cyclosporin A Combined with Glucocorticoid in the Treatment of Idiopathic Membranous Nephropathy

作　　者：樊小宝 张蓬杰[1] 王晓明[1] 杜鹏[1] FAN Xiaobao;ZHANG Pengjie;WANG Xiaoming;DU Peng(Center of Kidney Diseases and Hemodialysis,Shanxi Province People’s Hospital,Xi’an 710068,China)

机构地区：[1]陕西省人民医院肾病血透中心,西安710068

出　　处：《宁夏医科大学学报》2020年第5期517-521,共5页Journal of Ningxia Medical University

基　　金：陕西省社会发展科技攻关项目(2016SF-013)。

摘　　要：目的探讨环孢素联合糖皮质激素治疗特发性膜性肾病(IMN)的临床有效性及安全性。方法收集经肾活检确诊的89例IMN患者,41例采用环孢素联合糖皮质激素治疗(环孢素组),48例采用环磷酰胺联合糖皮质激素治疗(环磷酰胺组),观察两组患者治疗后24 h尿蛋白、血清白蛋白、甘油三酯、胆固醇、白细胞计数、血糖和血肌酐水平变化,比较两组患者两年内不良反应发生及疾病复发情况。结果治疗6、12个月后,两组24 h尿蛋白、甘油三酯、胆固醇水平较治疗前下降,血清白蛋白较治疗前升高(P均<0.05)。环孢素组患者治疗6个月、12个月的总有效率分别为73.17、87.80%,均高于环磷酰胺组的58.33、72.92%(P均<0.05)。随访至24个月,环孢素组和环磷酰胺组患者不良反应发生率差异无统计学意义(P>0.05);环孢素组两年复发率(4.88%)低于环磷酰胺组(16.67%)(P<0.05)。结论在特发性膜性肾病的治疗中,环孢素A联合糖皮质激素效果肯定,与环磷酰胺相比,缓解率高、复发率低,并未增加不良反应的发生。Objective To evaluate the efficacy and safety of cyclosporin A combined with glucocorticoid in the treatment of idiopathic membranous nephropathy(IMN).Methods From January 2016 to December 2018,89 IMN patients were admitted in the hospital and diagnosed by the renal biopsy,41 cases were treated with cyclosporin A combined with glucocorticoid(cyclosporin group),48 cases were treated with cyclophosphamide combined with glucocorticoid(cyclophosphamide group).The changes of urine protein quantity,serum albumin,triglyceride,cholesterol,white blood cell count,blood glucose and serum creatinine were observed 24 hours after treatment in the two groups,and the adverse reactions and disease recurrence in two years were compared between the two groups.Results After 6 and 12 months of treatment,the levels of urine protein,triglyceride and cholesterol in the two groups decreased and serum albumin increased(P all<0.05).The total effective rate of cyclosporine group was 73.17%and 87.80%in 6 and 12 months,respectively,which were higher than that of cyclophosphamide group(58.33 and 72.92%)(P<0.05).After 24 months follow-up,there was no significant difference in the incidence of adverse reactions between cyclosporine group and cyclophosphamide group(P>0.05);the recurrence rate of cyclosporine group in 2 years(4.88%)was lower than that of cyclophosphamide group(16.67%)(P<0.05).Conclusion In the treatment of idiopathic membranous nephropathy,cyclosporine a combined with glucocorticoid has a positive effect.Compared with cyclophosphamide,it has a high remission rate and a low recurrence rate,and does not increase the incidence of adverse reactions.

关 键 词：特发性膜性肾病 环孢素 环磷酰胺 糖皮质激素 疗效 

分 类 号：R692[医药卫生—泌尿科学]