环磷酰胺-沙利度胺-地塞米松治疗伴单克隆免疫球蛋白沉积的增生性肾小球肾炎  

Cyclophosphamide-thalidomide-dexamethasone for proliferative glomerulonephritis with monoclonal immunoglobulin deposits

作　　者：王佳玮 邱丹丹 周后安 王佑良 俞肄茹 陈朝红 程震 WANG Jiawei;QIU Dandan;ZHOU Houan;WANG Youliang;YU Yiru;CHEN Zhaohong;CHENG Zhen(National Clinical Research Center for Kidney Diseases,Jinling Hospital,Affiliated Hospital of Medical School,Nanjing University,Nanjing 210016,China)

机构地区：[1]南京大学医学院附属金陵医院(东部战区总医院)国家肾脏疾病临床医学研究中心,南京210016

出　　处：《肾脏病与透析肾移植杂志》2024年第6期508-513,共6页Chinese Journal of Nephrology,Dialysis & Transplantation

基　　金：江苏省卫生健康委员会面上项目(H2023017);东部战区总医院院管课题(22LCZLXJS11;2023LCZLXA037)。

摘　　要：目的:评估环磷酰胺-沙利度胺-地塞米松(CTD)方案治疗伴单克隆免疫球蛋白沉积的增生性肾小球肾炎(PGNMID)的有效性及安全性。方法:回顾性分析2018年1月至2024年1月于国家肾脏疾病临床研究中心采用CTD方案治疗PGNMID患者的临床病理资料。结果:筛选纳入CTD方案治疗的22例患者,初发初治组16例,复发难治组6例。中位随访21月,中位缓解时间约9月。随访期内,90.9%达肾脏缓解,45.5%完全缓解。所有患者中位尿蛋白定量从3.53(2.10,6.41)g/24h降至0.71(0.41,2.15)g/24h,中位血清肌酐从122.5(84.4,150.3)μmol/L降至99.9(70.7,124.0)μmol/L。其中,2例复发,1例进入终末期肾病。沙利度胺中位使用剂量75(50,100)mg/d,严重不良反应发生率9.1%(2/22),骨髓抑制和周围神经损伤各1例。结论:CTD方案治疗PGNMID有效,严重不良反应少,耐受性较好,远期疗效和安全性还需要进一步观察。Objective:To evaluate the efficacy and safety of cyclophosphamide-thalidomide-dexamethasone(CTD)therapy in patients with proliferative glomerulonephritis with monoclonal immunoglobulin deposits(PGNMID).Methodology:The clinicopathological data of PGNMID patients who were treated with CTD protocol from January 2018 to January 2024 were retrospectively analyzed.Results:22 patients were included in the CTD treatment protocol,consisting of 16 patients in the first episode,first-treatment group,and 6 patients in the relapsed-refractory group.The median follow-up period was 21 months,with a median remission time of approximately 9 months.During the follow-up period,90.9%of patients achieved renal remission,45.5%complete remission.Median urine protein quantification decreased from 3.53(2.10,6.41)g/24h to 0.71(0.41,2.15)g/24h in all patients,and median serum creatinine decreased from 122.5(84.4,150.3)μmol/L to 99.9(70.7,124.0)μmol/L.Of these patients,two relapsed,and one went into end stage kidney disease.The median thalidomide dose in the CTD group was 75(50,100)mg/d,with an overall incidence of serious adverse reactions of 9%(2/22),including one case each of myelosuppression and peripheral neuropathy.Conclusion:The CTD regimen is effective in treating patients with PGNMID,with a low incidence of serious adverse effects and good tolerability.Further observations are needed regarding the impact on long-term efficacy and safety.

关 键 词：伴单克隆免疫球蛋白沉积的增生性肾小球肾炎 环磷酰胺-沙利度胺-地塞米松 疗效 不良反应 

分 类 号：R692.31[医药卫生—泌尿科学]