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目的:观察霉酚酸酯和环磷酰胺治疗表现为肾病综合征的紫癜性肾炎的临床疗效。方法:将我科2001年6月至2011年6月的42例表现为肾病综合征并确诊为紫癜性肾炎的患者随机分为两组:一组用激素联合霉酚酸酯,另一组用激素联合环磷酰胺,治疗3、6、9个月,分别观察两组患者的临床疗效,并比较治疗前后24 h尿蛋白定量、尿红细胞计数、血浆白蛋白变化。结果:治疗3、6、9个月临床完全缓解率霉酚酸酯组与环磷酰胺组分别为38.1%和33.3%、61.9%和47.6%、80.9%和66.7%(P>0.05);临床部分缓解率霉酚酸酯组与环磷酰胺组分别为42.8%和38.1%、28.6%和33.3%、14.3%和23.8%(P>0.05);总缓解率(完全+部分缓解)霉酚酸酯组与环磷酰胺组分别为80.9%和71.4%、90.5%和80.9%、95.2%和90.5%(P>0.05)。治疗6、9个月时尿蛋白缓解率霉酚酸酯组高于环磷酰胺组,分别为80.6%与53.8%(P<0.05)、和91.2%与66.4%(P<0.05)。治疗3个月后两组肉眼血尿均消失,治疗6个月时血尿缓解率霉酚酸酯组高于环磷酰胺组(67.9%与38.7%,P<0.05);9个月时两组血尿缓解率相近(93.5%与90.8%,P>0.05)。霉酚酸酯组8例出现不良反应,包括胃肠道反应、上呼吸道感染和轻度肝损害。环磷酰胺组12例出现不良反应,包括胃肠道反应、白细胞下降、轻度肝损害、上呼吸道感染和脱发。结论:霉酚酸酯和环磷酰胺联合中等量激素治疗表现为肾病综合征的紫癜性肾炎临床完全缓解率均较高,但前者在缓解蛋白尿和血尿方面更有优势,且不良反应较少。紫癜性肾炎对激素和免疫抑制剂敏感,预后良好。
Objective: To observe the clinical efficacy of mycophenolate mofetil and cyclophosphamide in the treatment of purpuric nephritis with nephrotic syndrome. Methods: Forty-two patients with Nephrotic Syndrome who were diagnosed as purpuric nephritis from June 2001 to June 2011 were randomly divided into two groups: one with steroid combined with mycophenolate mofetil and the other with Hormones combined with cyclophosphamide for 3, 6, and 9 months. The clinical efficacy of the two groups were observed. The urinary protein, urinary erythrocyte count and plasma albumin were compared 24 h after treatment. Results: The clinical complete response rate was 38.1% and 33.3%, 61.9% and 47.6%, 80.9% and 66.7% respectively in the groups with mycophenolate mofetil and cyclophosphamide at 3, 6 and 9 months (P> 0.05) The partial response rates of mycophenolate mofetil and cyclophosphamide were 42.8% and 38.1%, 28.6% and 33.3%, 14.3% and 23.8%, respectively (P> 0.05). The overall response rate (complete and partial response) The ester group and the cyclophosphamide group were 80.9% and 71.4%, 90.5% and 80.9%, 95.2% and 90.5%, respectively (P> 0.05). The urinary protein remission rates at 6 and 9 months were higher in patients with cyclophosphamide at 80.6% and 53.8% (P <0.05), and 91.2% and 66.4% (P <0.05), respectively. After 3 months of treatment, the gross hematuria disappeared in both groups. At 6 months, the rate of hematuria in mycophenolate mofetil group was higher than that in cyclophosphamide group (67.9% vs 38.7%, P <0.05) Remission rates were similar (93.5% and 90.8%, P> 0.05). Mycophenolates group, 8 cases of adverse reactions, including gastrointestinal reactions, upper respiratory tract infection and mild liver damage. Adverse reactions occurred in 12 patients in the cyclophosphamide group, including gastrointestinal reactions, leukopenia, mild liver damage, upper respiratory tract infections and alopecia. CONCLUSION: Mycophenolate mofetil and cyclophosphamide combined with moderate hormonal treatment of nephrotic syndrome in patients with purpura nephritis clinical complete remission rate were high, but the former in alleviating proteinuria and hematuria more advantages and less adverse reactions . Purpura nephritis is sensitive to hormones and immunosuppressants and has a good prognosis.