小剂量多靶点免疫抑制治疗中老年特发性膜性肾病的有效性及安全性研究

发布时间：2018-09-18 16:32

【摘要】：目的探讨小剂量激素联合小剂量环孢素A和来氟米特多靶点免疫抑制治疗中老年特发性膜性肾病的有效性及安全性。方法将入选的48例特发性膜性肾病患者分为多靶点治疗组和对照组。多靶点治疗组联合应用泼尼松0.5mg·kg-1·d-1+环孢素A 2mg·kg-1·d-1+来氟米特10mg/d。对照组联合应用泼尼松1mg·kg-1·d-1+环磷酰胺100mg/d。治疗8周后泼尼松逐渐减量,每2周减少5mg,至10mg/d停止减量;环磷酰胺总量达10.0g停药。检测治疗前及治疗后1、3、6个月患者24h尿蛋白定量、血浆清蛋白、血肌酐、血糖及肝功能等指标,比较两组患者的临床疗效及药物不良反应。结果与治疗前比较,两组患者的尿蛋白定量均明显降低,血浆清蛋白水平明显升高,差异有统计学意义(P0.05)。治疗3个月后,多靶点治疗组尿蛋白定量水平低于对照组(P0.01),血浆清蛋白水平高于对照组(P0.01)。治疗6个月后,多靶点治疗组完全缓解率66.7%,明显高于对照组(31.8%,P0.05);多靶点治疗组总有效率87.5%,明显高于对照组(59.1%,P0.05)。多靶点治疗组不良反应发生率明显低于对照组(P0.05)。结论小剂量激素联合小剂量环孢素A、来氟米特多靶点免疫抑制治疗中老年特发性膜性肾病疗效显著,优于传统的激素联合环磷酰胺方案,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.
【作者单位】：河北省唐山市工人医院肾内科;
【基金】：河北省唐山市科技攻关项目(13130266b)
【分类号】：R692

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