环磷酰胺联合糖皮质激素治疗不同病理分期特发性膜性肾病的疗效观察  

Observation on efficacy of cyclophosphamide combined with glucocorticoids in treatment of idiopathic membranous nephropathy of different pathological stage

作　　者：钟兰 温文斌[2] Zhong Lan;Wen Wenbin(Graduate School of Changzhi Medical College,Changzhi,Shanxi 046099,China;Heji Hospital Affiliated to Changzhi Medical College,Changzhi,Shanxi 046099,China)

机构地区：[1]长治医学院研究生院,山西长治046099 [2]长治医学院附属和济医院,山西长治046099

出　　处：《齐齐哈尔医学院学报》2024年第13期1230-1234,共5页Journal of Qiqihar Medical University

摘　　要：目的分析比较不同病理分期特发性膜性肾病(IMN)经环磷酰胺(CTX)静脉冲击联合口服糖皮质激素(GC)治疗的疗效情况,为临床治疗IMN提供依据。方法回顾性分析2017年1月—2022年12月某医学院附属和平医院及附属和济医院肾内科经肾穿刺活检确诊为IMN且接受CTX静脉冲击联合口服GC治疗患者的临床资料及实验室资料。按照IMN病理分期进行分组,随访12个月,分析比较不同病理分期组IMN患者的基线资料及治疗后各时间点的疗效差异。结果共收集到符合纳入标准的80例IMN患者,其中Ⅰ期组0例,Ⅱ期组65例,Ⅲ期组15例,Ⅳ期组0例。基线资料分析结果:Ⅱ期组和Ⅲ期组在年龄、性别、血压、病程、就诊原因、24 h尿蛋白(24 h UTP)、血清总蛋白(TP)、血清白蛋白(SA)、血肌酐(Scr)、估算肾小球滤过率(eGFR)、血尿酸(UA)、甘油三酯(TG)、总胆固醇(TC)、补体C4、补体C3、免疫球蛋白G(IgG)等指标比较,差异无统计学意义(P>0.05)。CTX+GC治疗后疗效及疗效相关指标分析结果:Ⅱ期组和Ⅲ期组在完全缓解率、部分缓解率、无效率及总缓解率等指标比较,差异无统计学意义(P>0.05)。Ⅱ期组与Ⅲ期组接受治疗后24 h UTP不存在统计学差异(P>0.05);Ⅱ期组和Ⅲ期组的24 h UTP均对时间差异有统计学意义(P<0.05),提示治疗时间越长,24 h UTP有下降趋势。Ⅱ期组和Ⅲ期组接受治疗后SA存在统计学差异(P<0.05),治疗3个月时Ⅲ组SA 34.50(32.40,38.00)g/L,Ⅱ期组SA 31.50(25.95,35.10)g/L,Ⅲ期组高于Ⅱ期组,差异有统计学意义(P<0.05);Ⅱ期组和Ⅲ期组SA均对时间差异有统计学意义(P<0.05),提示治疗时间越长,SA有上升趋势。Ⅱ期组与Ⅲ期组患者接受治疗后Scr不存在统计学差异(P>0.05);Ⅱ期组和Ⅲ期组的Scr均对时间差异无统计学意义(P>0.05)。结论CTX静脉冲击联合口服GC治疗方案对不同病理分期IMN患者均有效,在治疗开始后1年内,随着治疗时间的延长,2Objective To investigate the curative effect of intravenous cyclophosphamide(CTX)combined with oral administration of glucocorticoid(GC)in treating idiopathic membranous nephropathy(IMN)of different pathological stages,and to provide evidence for clinical treatment of IMN.Methods Clinical and laboratory data of patients diagnosed with IMN by renal biopsy and receiving CTX intravenous shock combined with oral GC treatment in the nephrology department of Affiliated Heping and Affiliated Heji Hospital of××Medical College from January 2017 to December 2022 were analyzed retrospectively.The patients were grouped according to the pathological stages of IMN and followed up for 12 months,the baseline data of IMN patients in different pathological stages and the difference of curative effect at each time point after treatment were analyzed and compared.Results A total of 80 patients suffering from IMN who met the inclusion criteria were collected in this study,including 0 patients in stageⅠgroup,65 patients in stageⅡgroup,15 patients in stageⅢgroup,and 0 patients in stageⅣgroup.Baseline data analysis results:There were no significant differences in age,sex,blood pressure,course of disease,reason for treatment,24-hour urinary total protein,total protein,serum albumin,serum creatinine,eGFR,uric acid,triglyceride,total cholesterol,supplement C4,supplement C3,and immunoglobulin G between the phaseⅡgroup andⅢgroup.Analysis results of efficacy and efficacy related indicators after CTX+GC treatment:There were no statistical significance in complete remission rate,partial remission rate,inefficiency and total remission rate between the phaseⅡgroup and the phaseⅢgroup.There was no significant difference in 24-hour urinary total protein after treatment between the stageⅡgroup and the stageⅢgroup.The 24-hour total urinary protein of stageⅡgroup and stageⅢgroup had a statistically significant difference in time(P<0.05),indicating that the longer the treatment time,the decrease trend of 24-hour urinary total

关 键 词：特发性膜性肾病 环磷酰胺 糖皮质激素 病理分期 疗效 

分 类 号：R692.6[医药卫生—泌尿科学]