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时间:2018-04-19
《小剂量环孢素联合小剂量激素治疗膜性肾病的疗效观察》由会员上传分享,免费在线阅读,更多相关内容在应用文档-天天文库。
1、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奎冀罜宋岩解放军总医院第一附属医院肾内科摘要: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(idiopathicmembranousnephropathy,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U1N患者,予以小剂量环孢素(l.S^Omg^kg^d1)联合小剂量糖皮质激素(泼尼松0.2°.4mg-kg1-dH),治疗吋间12M个月,随访吋间12M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1
2、2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奋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
3、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。关键词:特发性膜性肾病;糖皮质激素;环孢素;收稿日期:2017-02-12基金:首都卫生发展科研专项项目(No.2011-5002-04)Clinicalobservationoflow-dosecyclosporineAcombinedwithsmalldoseofhormoneinthetreatmentofidiopathicmembranousnephropathyZHANGJia
4、nLIJi一junSONGYanDepartmentofNephrology,theFirstAffiliatedHospitalofPLAGeneralHospital;Abstract:ObjectiveToobservetheclinicaleffectandadversereactionsoflowdoseofcyclosporineAcombinedwithsmalldoseofhormoneinthetreatmentofidiopathicmembranousnephropathy,andtoexplorethesafeand
5、effectivetreatmentstrategy.MethodsThirty-sevencasesofidiopathicmembranousnephropathyadmittedattheDepartmentofNephrology,theFirstAffiliatedHositalofPLAGeneralHospitalweregivenlow-dosecyclosporineA(1.53.0mg/kgeveryday)combinedwithsmalldoseofglucocorticoid(prednisone0.2〜0.4mg
6、/kgeveryday).Thetreatmentcoursewas12~24months,andthefollow-upperiodwas12-24months.Theclinicalefficacy,adversereactionsandcomplicationswereobserved.At12thmonthduringthefollow-upperiod,thepatientsweredividedintoeffectivegroup(completeorpartialremission)andineffectivegroup(no
7、remission).Thesinglefactoranalysiswasusedtoanalyzetheprognosticfactors.ResultsIn37cases,23cases(62%)achievedcompleteremission,10cases(27%)partialremission,and4cases(11%)noremission.EightcaseshadtheeffectofcyclosporineAwithin4weeks,and4casesrelapsedinstoppingdrugorreducingp
8、rocess.Univariateanalysisshowednostatisticallysignificantdifferenceingenderbetweentheeffe
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