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目的观察霉酚酸酯与小剂量糖皮质激素联合方案治疗难治性肾病综合征的临床效果。方法对照组入选病例给予泼尼松0.8-1.0mg.kg-1.d-1早晨顿服,后递减至10mg/d,维持半年至1年。观察组入选病例采用霉酚酸酯联合小剂量泼尼松治疗,疗程不得超6个月。观察两组患者常规24h尿蛋白定量、BUN、Scr、肝功能及血浆白蛋白、血脂,同时观察药物不良反应。结果治疗后治疗组总有效率与对照组比较差异有统计学意义(P<0.05);两组患者治疗后与治疗前比较24h尿蛋白定量、血肌酐、血浆白蛋白、血胆固醇等指标,差异有统计学意义(P<0.01);治疗组与对照组比较,差异有统计学意义(P<0.05);霉酚酸酯组患者用药2周后,7例患有胃部不适、恶心、呕吐及轻度腹泻,经对症处理后症状缓解,未影响继续治疗,未发现明显肝功能、血糖及心肌酶异常改变。结论霉酚酸酯与小剂量糖皮质激素联合方案治疗难治性肾病综合征疗效明显,不良反应轻微。
Objective To observe the clinical effect of combination of mycophenolate mofetil and low dose glucocorticoid on refractory nephrotic syndrome. Methods Patients in the control group were given prednisone 0.8-1.0mg.kg-1.d-1 in the morning, and then decreased to 10mg / d for 6 months to 1 year. Observation group selected cases with mycophenolate mofetil combined with low-dose prednisone treatment, the course of not exceeding 6 months. Observe the routine 24-hour urinary protein, BUN, Scr, liver function, serum albumin and blood lipid in the two groups and observe the adverse drug reactions. Results After treatment, the total effective rate in the treatment group was significantly lower than that in the control group (P <0.05). The urinary protein excretion, serum creatinine, plasma albumin, blood cholesterol and other indexes of the two groups were significantly higher than those before treatment (P <0.01). The difference between the treatment group and the control group was statistically significant (P <0.05). After 2 weeks of treatment, the patients in the mycophenolate mofetil group had 7 cases of stomach discomfort, nausea and vomiting And mild diarrhea, after symptomatic treatment of symptoms, did not affect the continued treatment, no significant liver function, abnormal glucose and myocardial enzymes. Conclusion Mycophenolate mofetil and small dose of glucocorticoid combined treatment of refractory nephrotic syndrome has obvious curative effect with minor adverse reactions.