不同治疗方案对特发性膜性肾病疗效的临床对照研究

罗曼宇; 刘丽华; 刘声茂; 张冬梅

doi:10.3969/j.issn.1671-2390.2019.11.002

不同治疗方案对特发性膜性肾病疗效的临床对照研究

A controlled clinical study of efficacy of different treatment regimens for idiopathic membranous nephropathy

摘要

摘要: 目的探讨比较激素（prednisone，Pre）联合环磷酰胺（cyclophosphamide，CTX）交替治疗方案（即改良Ponticelli方案，MPR方案）、激素联合CTX方案（Pre/CTX方案）和激素联合他克莫司（tacrolimus，TAC）方案（Pre/TAC方案）在治疗特发性膜性肾病（idiopathic membranous nephropathy，IMN）中的临床疗效及不良反应。方法回顾性分析67例于吉林大学第二医院接受肾活检诊断为IMN的患者的尿蛋白、白蛋白等临床资料，按治疗方案不同分为MPR组、Pre/CTX组和Pre/TAC组，所有患者均治疗6个月，观察3组患者治疗3个月和治疗6个月时的临床疗效，同时监测治疗过程中的不良反应。结果在治疗前，3组患者各指标无明显差异。治疗3个月时，MPR组23例患者中8例（34.7%）达部分缓解，有效率为34.7%；Pre/CTX组24例患者中有1例（4.2%）死亡，1例（4.2%）达完全缓解，8例（33.3%）达部分缓解，有效率为37.5%；Pre/TAC组20例患者中有8例（40.0%）达部分缓解，有效率为40.0%；3组有效率比较差异无统计学意义。治疗6个月时，MPR组患者死亡1例（4.3%），剩余22例患者中1例（4.3%）达完全缓解，12例（52.2%）达部分缓解，有效率为56.5%；Pre/CTX方案组剩余23例患者中有2例（8.7%）达完全缓解，17例（73.9%）达部分缓解，有效率为82.6%；Pre/TAC组20例患者中有1例（5.0%）达完全缓解，12例（60.0%）达部分缓解，有效率为65.0%；3组有效率比较差异无统计学意义。治疗过程中MPR组不良反应相对较少。结论 MPR、Pre/CTX及Pre/TAC方案治疗IMN时总有效率相当；MPR方案具有疗程短和激素累积剂量少的特点，可能具有较高的安全性。

Abstract: Objective To evaluate the clinical efficacy and safety of the following different treatment regimens for idiopathic membranous nephropathy(IMN):modified Ponticelli regimen (MPR, alternating therapy of hormone (Prednisone,Pre) combined with Cyclophosphamide (CTX), prednisone combined with CTX (Pre/CTX) and prednisone combined with Tacrolimus (Pre/TAC). Methods A total of 67 patients diagnosed with IMN by kidney biopsy from the 2^nd Hospital of Jilin University were analyzed on their clinical information about urine protein and albumin. Based on the treatment regimens, they were divided into MPR group, Pre/CTX group and Pre/TAC group. All the patients were treated for 6 months. We observed clinical efficacy in the three groups for 3-month and 6-month treatment, and monitored adverse reactions during the treatment course. Results No significant difference was observed at baseline before treatment. After 3-month treatments, in the MPR group, 8 (34.7%) of 23 patients reached partly remission and the effectiveness rate is 34.7%; in the Pre/CTX group, 1 (4.2%) of 24 patients died, 1 (4.2%) reached complete remission, 8 (33.3%) reached partly remission and the effectiveness rate is 37.5%; and in the Pre/TAC group, 8 (40.0%) of 20 Pre/TAC group patients reached partly remission and the effective rate is 40.0%. The above results in the three groups have no statistical difference. After 6-months treatments, in the MPR group, 1 (4.3%) of 23 patients died, 1 (4.3%) of the rest 22 patients reached complete remission, 12 (52.2%) reached partly remission and the effectiveness rate is 56.5%; in the Pre/CTX group, 2 (8.7%) of the rest 23 patients reached complete remission, 17 (73.9%) reached partly remission and the effective rate is 82.6%; and in the Pre/TAC group, 1 of 20 patients (5.0%) reached complete remission, 12 (60.0%) reached partly remission and the effective rate is 65.0%. The results in the 3 groups have no statistical difference. MPR had less adverse reactions during the treatments. Conclusions MPR, Pre/CTX and Pre/TAC regimens have comparable effectiveness for IMN; the MPR regimen is characterized by short treatment course and less prednisone accumulation dose, and so may have a high level of safety.

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