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目的:比较激素联合不同免疫抑制剂治疗高危因素特发性膜性肾病临床疗效,以探讨合理的治疗方案。方法:随机将2001年5月至2011年5月在我院确诊的46例高危因素的特发性膜性肾病患者分为3组,分别给予甲基泼尼松龙与环磷酰胺、环孢素A或霉酚酸酯中的一种联合使用,总疗程12个月,比较各组治疗方案的临床疗效。结果:(1)治疗前3组患者血压、血肌酐和24 h尿蛋白定量比较无显著性(P>0.05)。(2)甲基泼尼松龙+环磷酰胺、甲基泼尼松龙+环孢素A和甲基泼尼松龙+霉酚酸酯总缓解率分别为53.3%、80.0%和43.8%,甲基泼尼松龙+环孢素A与其余两组比较总缓解率较高,且有显著性(P<0.05);甲基泼尼松龙+环磷酰胺和甲基泼尼松龙+霉酚酸酯两组之间总缓解率无明显差异(P>0.05)。结论:激素联合免疫抑制剂治疗高危因素的特发性膜性肾病,可明显地提高患者的蛋白尿缓解率,其中甲基泼尼松龙+环孢素A总缓解率较高,且优于其他免疫抑制剂,但其复发率较高,肾脏药物不良反应大,临床选用时需谨慎。
Objective: To compare the clinical efficacy of hormones combined with different immunosuppressive agents in the treatment of idiopathic membranous nephropathy with high risk factors, so as to explore a reasonable treatment plan. Methods: Forty-six patients with idiopathic membranous nephropathy who were diagnosed as risk factors in our hospital from May 2001 to May 2011 were randomly divided into three groups: methylprednisolone, cyclophosphamide, A or mycophenolate in combination with a total course of 12 months, compared the clinical efficacy of treatment programs in each group. Results: (1) There was no significant difference in the blood pressure, serum creatinine and 24 h urinary protein among the three groups before treatment (P> 0.05). (2) The total remission rates of methylprednisolone + cyclophosphamide, methylprednisolone + cyclosporine A and methylprednisolone + mycophenolate were 53.3%, 80.0% and 43.8% respectively , Methylprednisolone + cyclosporin A compared with the other two groups, the total remission rate was higher (P <0.05); methylprednisolone + cyclophosphamide and methylprednisolone + Mycophenolate mofetil no significant difference between the two groups (P> 0.05). Conclusion: Hormone combined with immunosuppressive agents in the treatment of idiopathic membranous nephropathy with high risk factors can significantly improve the patients’ proteinuria remission rate. The total remission rate of methylprednisolone and cyclosporin A is higher than that Other immunosuppressive agents, but its higher recurrence rate, renal drug adverse reactions, the clinical selection should be cautious.