發(fā)布時(shí)間：2018-03-31 22:19

  本文選題：增殖性狼瘡性腎炎　切入點(diǎn)：嗎替麥考酚酯　出處：《南京大學(xué)》2017年碩士論文

【摘要】：目的:分析激素聯(lián)合嗎替麥考酚酯(MMF)治療不同類型增殖性狼瘡性腎炎(LN)的療效及MMF治療時(shí)間對(duì)遠(yuǎn)期預(yù)后的影響。方法:2000年1月至2012年12月在南京總醫(yī)院國(guó)家腎臟疾病臨床醫(yī)學(xué)研究中心就診,經(jīng)腎活檢病理診斷為Ⅲ型、Ⅳ型、Ⅲ+Ⅴ型及Ⅳ+Ⅴ型LN并接受激素和MMF誘導(dǎo)治療≥6月的229例患者納入本研究。根據(jù)MMF維持治療療程不同分為MMF長(zhǎng)期維持組(組Ⅰ:緩解后MMF維持治療≥24月)、MMF短期維持組(組Ⅱ:緩解后MMF維持時(shí)間24月)、非MMF維持組(組Ⅲ:緩解后即更換為其它方案維持)。誘導(dǎo)治療療效分為完全緩解(CR)、部分緩解(PR)和未緩解(NR)。復(fù)發(fā)包括腎臟病復(fù)發(fā)和腎外復(fù)發(fā)。復(fù)合腎臟終點(diǎn)事件包括終末期腎病(ESRD)、肌酐倍增或eGFR下降≥50%。采用SPSS 22.0統(tǒng)計(jì)軟件進(jìn)行數(shù)據(jù)分析,分析MMF治療療效并比較不同MMF維持治療時(shí)間組的復(fù)發(fā)率及患者遠(yuǎn)期預(yù)后差異。結(jié)果:229例MMF誘導(dǎo)治療的增殖性LN患者中214例(93.4%)獲得緩解,治療總緩解率(CR率和PR率)為93.4%,CR率為61.1%,15例無緩解。不同病理類型LN的MMF誘導(dǎo)緩解率不同,增殖性LN(Ⅲ型、Ⅳ型)總緩解率顯著高于增殖性 LN 合并V型 LN(包括Ⅲ+Ⅴ型、Ⅳ+Ⅴ型)(95.2%vs 86.1%,P0.05),CR,率也顯著高于合并V型病變的增殖性LN(66.8%vs 37.2%,P0.001)。組Ⅰ、組Ⅱ、組Ⅲ分別84例、84例和28例,三組隨訪時(shí)間分別為88(54.25,111.5)月、84.5(33.5,104)月和 79.5(33.25,116.25)月,MMF 治療時(shí)間分別為 50(37,72.5)月、16.5(12,22.75)月和 8(7,9)月。隨訪期間,共 68例(34.70%)復(fù)發(fā),組Ⅰ的復(fù)發(fā)率(22.6%)顯著低于組Ⅱ(44%,P0.05)和組Ⅲ(42.9%,P0.05)。多因素COX回歸分析發(fā)現(xiàn),組Ⅱ(HR 2.13,950%CI 1.01～4.47,P=0.046)和組Ⅲ(HR 3.25,95%CI 1.83～5.76,P0.001)的復(fù)發(fā)風(fēng)險(xiǎn)顯著高于組Ⅰ,誘導(dǎo)治療后僅達(dá)部分緩解者(HR 1.86,95%CI 1.10～3.16,P 0.021)的復(fù)發(fā)風(fēng)險(xiǎn)高。隨訪中18例發(fā)生復(fù)合腎臟終點(diǎn)事件(E SRD 1例、肌酐倍增或eGFR下降≥50%17例),組Ⅰ復(fù)合腎臟終點(diǎn)事件發(fā)生率(7.1%)低于組Ⅱ(10.7%)和組Ⅲ(10.70%),但無統(tǒng)計(jì)學(xué)差異。結(jié)論:MMF治療增殖性LN(Ⅲ型、Ⅳ型)緩解率較高,但治療合并V型的增殖性LN的緩解率較低。MMF治療緩解后繼續(xù)MMF維持,復(fù)發(fā)率和腎臟終點(diǎn)事件發(fā)生率低。
[Abstract]:Objective: analysis of glucocorticoid combined with mycophenolate mofetil (MMF) in treatment of different types of proliferative lupus nephritis (LN) and the clinical effects of MMF treatment on long-term prognosis. Methods: from January 2000 to December 2012 at the national kidney disease diagnosis clinical medical research center of Nanjing general hospital, by renal biopsy for the diagnosis of type III type IV, III, and IV + V + V LN and acceptance of this study included 229 patients with MMF and hormone induction therapy than the June patients. According to the MMF maintenance treatment were divided into MMF group (group I: maintain long-term remission after MMF 24 months, MMF = maintenance therapy) group (group II short-term maintenance MMF: after remission duration 24 months), non MMF group (Group III: maintain remission after replacement for other maintenance scheme). Induction therapy efficacy is divided into complete remission (CR), partial remission (PR) and non remission (NR). The recurrence including kidney disease recurrence and renal relapse. The composite renal end point event package 鎷粓鏈湡鑲劇梾(ESRD),鑲岄厫鍊嶅鎴杄GFR涓嬮檷鈮，

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