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目的回顾性观察糖皮质激素联合小剂量吗替麦考酚酯(MMF)对IgA肾病的临床疗效及安全性。方法 2010年9月-2012年9月在我科门诊就诊的28例IgA肾病患者接受了小剂量MMF联合激素治疗。醋酸泼尼松起始剂量为0.6 mg/(kg.d),MMF起始剂量为0.5～1.0 g/d,2～4周内调节药物剂量使血药浓度(MPA-AUC)维持在30～60 mg.h/L。治疗前及治疗后每月随访观察血清肌酐、血清白蛋白、尿蛋白定性、24 h尿蛋白定量及药物不良反应等指标。诱导期初定为6个月,若6个月未完全缓解(CR)则延长至9个月,总疗程至少12个月,主要评价指标为诱导治疗期的完全缓解率。结果全部患者均完成了12个月的随访观察,全组28例中CR 8例(28.6%),部分缓解(PR)14例(50.0%),未缓解(NR)6例(21.4%),总有效率78.6%。随访过程中,3例患者出现呼吸道感染,其中2例住院治疗;2例患者出现尿路感染,1例患者出现腹泻。结论小剂量MMF治疗IgA肾病安全、有效且能在一定程度上节省患者费用,可作为其他免疫抑制方案治疗无效或复发时的一种治疗选择。
Objective To retrospectively observe the clinical efficacy and safety of glucocorticoid combined with low-dose mycophenolate mofetil (MMF) on IgA nephropathy. Methods 28 patients with IgA nephropathy treated in our clinic from September 2010 to September 2012 underwent low-dose MMF combined with hormone therapy. The initial dose of prednisone acetate was 0.6 mg / (kg.d) and the initial dose of MMF was 0.5-1.0 g / d. The drug dosage was adjusted within 2 to 4 weeks to maintain the plasma concentration (MPA-AUC) 60 mg.h / L. Serum creatinine, serum albumin, urine protein qualitative, 24 h urine protein quantitation and adverse drug reactions were observed before and after treatment. The induction period was initially set at 6 months. If 6 months did not complete remission (CR), the induction period was extended to 9 months with a total course of at least 12 months. The main evaluation index was the complete remission rate during induction therapy. Results All the patients were followed up for 12 months. Among 28 patients in the whole group, 8 (28.6%) were CR, 14 (50.0%) were partial remission (PR), 6 (21.4%) were untreated The total effective rate of 78.6%. During follow-up, 3 patients developed respiratory infections, 2 of whom were hospitalized; 2 had urinary tract infections and 1 had diarrhea. Conclusions Small dose MMF is safe and effective in treating IgA nephropathy and can save patients’ costs to a certain extent. It can be used as a treatment option for other immunosuppressive regimens when treatment is ineffective or relapse.