小剂量环孢素联合小剂量激素治疗膜性肾病的疗效观察

张健; 李冀军; 宋岩

doi:10.3969/j.issn.1671-2390.2017.11.007

小剂量环孢素联合小剂量激素治疗膜性肾病的疗效观察

Clinical observation of low-dose cyclosporine A combined with small dose of hormone in the treatment of idiopathic membranous nephropathy

摘要

摘要: 目的观察小剂量环孢素联合小剂量激素治疗特发性膜性肾病（idiopathic membranous nephropathy，IMN）的临床疗效以及不良反应，以探讨更加安全有效的治疗方案。方法选择37例解放军总医院第一附属医院收治的IMN患者，予以小剂量环孢素（1.5~3.0 mg·kg^-1·d^-1）联合小剂量糖皮质激素（泼尼松0.2~0.4 mg·kg^-1·d^-1），治疗时间12~24个月，随访时间12~24个月。观察临床疗效、不良反应及并发症发生情况。将37例IMN患者以第12个月随访疗效结果分为2组，完全或部分缓解的为有效组，未缓解的患者为无效组，采用单因素分析影响预后的相关因素。结果 37例患者治疗12个月后完全缓解23例（62.2%），部分缓解10例（27.0%），未缓解4例（11%）；其中8例应用环孢素+激素4周内起效，4例在停药或减量过程中复发。单因素分析显示治疗有效组和无效组中患者的性别构成无统计学意义（P > 0.05）。无效组患者的年龄、病理分期Ⅲ、IV期构成比例明显高于有效组，治疗前高血压、镜下血尿构成比例高于有效组，差异均有统计学意义（P < 0.05）。结论小剂量环孢素联合小剂量激素治疗IMN是有效的，治疗后患者的尿酸水平会明显升高，需要引起重视；尿酸的升高可能与环孢素造成的肾小管损伤有关。患者的年龄、病理分期、高血压、镜下血尿均影响治疗的效果。

Abstract: Objective To observe the clinical effect and adverse reactions of low dose of cyclosporine A combined with small dose of hormone in the treatment of idiopathic membranous nephropathy, and to explore the safe and effective treatment strategy.Methods Thirty-seven cases of idiopathic membranous nephropathy admitted at the Department of Nephrology, the First Affiliated Hosital of PLA General Hospital were given low-dose cyclosporine A (1.5~3.0 mg/kg every day) combined with small dose of glucocorticoid (prednisone 0.2~0.4 mg/kg every day). The treatment course was 12~24 months, and the follow-up period was 12-24 months. The clinical efficacy, adverse reactions and complications were observed. At 12th month during the follow-up period, the patients were divided into effective group (complete or partial remission) and ineffective group (no remission). The single factor analysis was used to analyze the prognostic factors.Results In 37 cases, 23 cases (62%) achieved complete remission, 10 cases (27%) partial remission, and 4 cases (11%) no remission. Eight cases had the effect of cyclosporine A within 4 weeks, and 4 cases relapsed in stopping drug or reducing process. Univariate analysis showed no statistically significant difference in gender between the effective and ineffective groups (P>0.05). The proportion of the patients in the ineffective group in age, and pathological stage Ⅲ and IV was significantly higher than that in the effective group, and the proportion of hypertension and microscopic hematuria before treatment in the ineffective group was significantly higher than that in the effective group (P<0.05).Conclusions Low dose of cyclosporine A combined with low dose of prednisone in the treatment of idiopathic membranous nephropathy is effective. But even such a low dose, after treatment the uric acid level is still significantly increased, because of renal tubular injury caused by cyclosporine A. The patient's age, pathological stage, hypertension and microscopic hematuria all affect the effectiveness of treatment.

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