【摘要】：目的探討小劑量激素聯(lián)合小劑量環(huán)孢素A和來氟米特多靶點免疫抑制治療中老年特發(fā)性膜性腎病的有效性及安全性。方法將入選的48例特發(fā)性膜性腎病患者分為多靶點治療組和對照組。多靶點治療組聯(lián)合應用潑尼松0.5mg·kg-1·d-1+環(huán)孢素A 2mg·kg-1·d-1+來氟米特10mg/d。對照組聯(lián)合應用潑尼松1mg·kg-1·d-1+環(huán)磷酰胺100mg/d。治療8周后潑尼松逐漸減量,每2周減少5mg,至10mg/d停止減量;環(huán)磷酰胺總量達10.0g停藥。檢測治療前及治療后1、3、6個月患者24h尿蛋白定量、血漿清蛋白、血肌酐、血糖及肝功能等指標,比較兩組患者的臨床療效及藥物不良反應。結(jié)果與治療前比較,兩組患者的尿蛋白定量均明顯降低,血漿清蛋白水平明顯升高,差異有統(tǒng)計學意義(P0.05)。治療3個月后,多靶點治療組尿蛋白定量水平低于對照組(P0.01),血漿清蛋白水平高于對照組(P0.01)。治療6個月后,多靶點治療組完全緩解率66.7%,明顯高于對照組(31.8%,P0.05);多靶點治療組總有效率87.5%,明顯高于對照組(59.1%,P0.05)。多靶點治療組不良反應發(fā)生率明顯低于對照組(P0.05)。結(jié)論小劑量激素聯(lián)合小劑量環(huán)孢素A、來氟米特多靶點免疫抑制治療中老年特發(fā)性膜性腎病療效顯著,優(yōu)于傳統(tǒng)的激素聯(lián)合環(huán)磷酰胺方案,且患者耐受性好。
[Abstract]:Objective to investigate the efficacy and safety of low dose hormone combined with low dose cyclosporine A and leflunomide multitarget immunosuppression in the treatment of senile idiopathic membranous nephropathy. Methods 48 patients with idiopathic membranous nephropathy were divided into multi-target therapy group and control group. Prednisone 0.5mg kg-1 d-1 cyclosporine A 2mg kg-1 d-1 leflunomide 10 mg / d. The control group was treated with prednisone 1mg kg-1 d-1 cyclophosphamide 100 mg / d. After 8 weeks of treatment, prednisone gradually decreased, reduced by 5 mg every 2 weeks, and the total amount of cyclophosphamide was 10.0 g. 24 hours urine protein, plasma albumin, serum creatinine, blood glucose and liver function were measured before treatment and 1, 6 months after treatment. The clinical efficacy and adverse drug reactions were compared between the two groups. Results compared with before treatment, the urine protein quantity and plasma albumin level of the two groups were significantly decreased and the difference was statistically significant (P0.05). After 3 months of treatment, the quantitative level of urinary protein in the multi-target group was lower than that in the control group (P0.01), and the plasma albumin level was higher than that in the control group (P0.01). After 6 months of treatment, the complete remission rate of the multi-target treatment group was 66.7, which was significantly higher than that of the control group (31.8% P0.05); the total effective rate of the multi-target treatment group was 87.5%, significantly higher than that of the control group (59.1% P0.05). The incidence of adverse reactions in the multi-target treatment group was significantly lower than that in the control group (P0.05). Conclusion low dose hormone combined with low dose cyclosporine A and leflunomide multiple target immunosuppressive therapy is more effective than traditional hormone combined with cyclophosphamide regimen in the treatment of elderly idiopathic membranous nephropathy.
【作者單位】： 河北省唐山市工人醫(yī)院腎內(nèi)科;
【基金】：河北省唐山市科技攻關項目(13130266b)
【分類號】：R692

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