嗎替麥考酚酯聯(lián)合糖皮質(zhì)激素治療特發(fā)性膜性腎病的療效觀察

陳曉霞　唐勇　胡慶

摘 要：目的 比較嗎替麥考酚酯和環(huán)磷酰胺治療特發(fā)性膜性腎病的有效性及安全性。方法 選擇2011年8月～2013年8月在遂寧市中心醫(yī)院確診為特發(fā)性膜性腎病的患者40例，隨機(jī)分為嗎替麥考酚酯治療組和環(huán)磷酰胺治療組，各20例，分別給予嗎替麥考酚酯和環(huán)磷酰胺聯(lián)合糖皮質(zhì)激素治療。在治療后6、12、24和36個月，檢測兩組患者尿蛋白定量、血清白蛋白、血肌酐、內(nèi)生肌酐清除率、膽固醇及甘油三酯，同時觀察并記錄兩組患者不良反應(yīng)情況。結(jié)果 治療12個月后，兩組患者尿蛋白定量、血清白蛋白、血肌酐及膽固醇水平較治療前均改善，但兩組間比較差異無統(tǒng)計學(xué)意義（P>0.05）。治療24月后，MMF組患者尿蛋白定量、血清白蛋白、膽固醇及甘油三酯分別為（1.19±5.15）g/24h、（40.14±3.96）g/L、（4.73±0.64）mmol/L和（1.88±0.28）mmol/L，而CTX組患者相應(yīng)指標(biāo)為（1.82±0.94）g/24h、（36.05±3.52）g/L、（5.33±0.76）mmol/L和（2.13±0.29）mmol/L，兩組患者數(shù)據(jù)比較，差異具有統(tǒng)計學(xué)意義（P<0.05）。兩組患者蛋白尿總緩解率在36個月后分別為90.00%和80.00%，差異無統(tǒng)計學(xué)意義（P>0.05）。兩組患者在藥物不良反應(yīng)比較，差異無統(tǒng)計學(xué)意義（P>0.05）。結(jié)論 嗎替麥考酚酯聯(lián)合糖皮質(zhì)激素治療特發(fā)性膜性腎病療效肯定，和環(huán)磷酰胺相比，其降尿蛋白效果更佳，同時藥物不良反應(yīng)更少。

關(guān)鍵詞：特發(fā)性膜性腎??；嗎替麥考酚酯；糖皮質(zhì)激素；環(huán)磷酰胺

中圖分類號：R692.3 文獻(xiàn)標(biāo)識碼：A DOI：10.3969/j.issn.1006-1959.2018.22.024

文章編號：1006-1959（2018）22-0089-04

Therapeutic Effect of Mycophenolate Mofetil Combined with Glucocorticoid on Idiopathic Membranous Nephropathy

CHEN Xiao-xia，TANG Yong，HU Qing，WANG Mao-he

（Department of Nephrology，Suining Central Hospital，Suining 629000，Sichuan，China）

Abstract：Objective To compare the efficacy and safety of mycophenolate mofetil and cyclophosphamide in the treatment of idiopathic membranous nephropathy.Methods A total of 40 patients with idiopathic membranous nephropathy diagnosed in Suining Central Hospital from August 2011 to August 2013 were randomly divided into the mycophenolate mofetil treatment group and the cyclophosphamide treatment group， 20 cases each. Treatment with mycophenolate mofetil and cyclophosphamide in combination with glucocorticoids. At 6， 12， 24， and 36 months after treatment， urine protein quantitation， serum albumin， serum creatinine， endogenous creatinine clearance， cholesterol， and triglycerides were measured in both groups， and adverse events were observed and recorded in both groups.Results After 12 months of treatment， urine protein quantitation， serum albumin， serum creatinine and cholesterol levels were improved in both groups， but there was no significant difference between the two groups（P>0.05）. After 24 months of treatment， urine protein quantitation， serum albumin， cholesterol and triglycerides in the MMF group were （1.19±5.15） g/24h， （40.14±3.96） g/L， （4.73±0.64） mmol/L， and （1.88±0.28） mmol/L， and the corresponding indicators of patients in the CTX group were （1.82±0.94） g/24h， （36.05±3.52） g/L，（5.33±0.76） mmol/L and （2.13±0.29） mmol/L， comparison of data between the two groups， the difference was statistically significant（P<0.05）. The total proteinuria remission rate in the two groups was 90.00% and 80.00% after 36 months， the difference was not statistically significant（P>0.05）. There were no significant differences in adverse drug reactions between the two groups（P>0.05）. Conclusion The efficacy of mycophenolate mofetil combined with glucocorticoid in the treatment of idiopathic membranous nephropathy is more effective than cyclophosphamide， and it has better urinary protein lowering effect and less adverse drug reactions.

Key words：Idiopathic membranous nephropathy；Mycophenolate mofetil；Glucocorticoid； Cyclophosphamide

特發(fā)性膜性腎?。╥diopathic membranous nephropathy，IMN）是引起成人腎病綜合征的常見原因之一，其在中老年人群中發(fā)病率約占60%[1]。其臨床表現(xiàn)為大量蛋白尿、低蛋白血癥。IMN患者的自然病程呈現(xiàn)出多樣性，約1/3的患者可出現(xiàn)自發(fā)緩解，1/3的患者表現(xiàn)為持續(xù)蛋白尿但腎功能長期穩(wěn)定，剩下1/3的患者則表現(xiàn)為腎功能緩慢進(jìn)展至終末期腎臟?。‥SRD）[2]。目前……