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目的:合并中等量蛋白尿的过敏性紫癜性肾炎的诱导治疗尚无确切方案,本研究通过回顾性比较分析了霉酚酸酯联合糖皮质激素的疗效与安全性。创新点:首次对霉酚酸酯联合糖皮质激素诱导治疗过敏性紫癜性肾炎进行了回顾性研究。方法:回顾性分析2007年1月至2013年6月间在浙江大学附属第一医院肾脏病中心接受肾穿刺活检,且经过3个月以上血管紧张素转换酶抑制剂(ACEI)/血管紧张素受体拮抗剂(ARB)治疗后蛋白尿为1.0~3.5 g/24 h的过敏性紫癜性肾炎患者95例。根据治疗方案分为3组,霉酚酸酯组(33例)在原剂量ACEI/ARB的基础上加用霉酚酸酯联合低剂量糖皮质激素,糖皮质激素组(31例)在原剂量ACEI/ARB的基础上加用全剂量糖皮质激素,对照组(31例)维持单用ACEI/ARB治疗,但可提高其剂量。患者随访观察6~78月(中位观察时间28月),霉酚酸酯组、糖皮质激素组与对照组的蛋白尿缓解率分别为72.7%、64.5%与45.2%(图1),发生副作用分别为17例、30例与6例,糖皮质激素组高脂血症与高血压发生率较高(表3)。结论:霉酚酸酯联合低剂量糖皮质激素可有效诱导缓解过敏性紫癜性肾炎,其缓解率与全剂量糖皮质激素治疗相当,且副作用较少。
OBJECTIVE: There is no exact solution to the induction therapy for allergic purpura nephritis with moderate proteinuria. In this study, we retrospectively analyzed the efficacy and safety of mycophenolate mofetil and glucocorticoid. Innovative point: For the first time, mycophenolate mofecoxib induction therapy for allergic purpura nephritis were retrospectively studied. Methods: A retrospective analysis of renal biopsy from January 2007 to June 2013 in the First Affiliated Hospital of Zhejiang University Kidney Disease Center, and after 3 months of angiotensin converting enzyme inhibitor (ACEI) / angiotensin 95 cases of allergic purpura nephritis patients with albuminuria 1.0 ~ 3.5 g / 24 h after ARB treatment. According to the treatment regimen, the patients were divided into three groups: mycophenolate mofetil group (n = 33) was given mycophenolate mofetil combined with low dose glucocorticoid on the basis of the original dose of ACEI / ARB, and glucocorticoid group (n = 31) ARB based on the use of full dose glucocorticoid, the control group (31 cases) to maintain single ACEI / ARB treatment, but can increase the dose. Patients were followed up for 6 months to 78 months (median observation time was 28 months), mycophenolate mofetil group and glucocorticoid group and control group proteinuria remission rates were 72.7%, 64.5% and 45.2% (Figure 1) occurred Side effects were 17 cases, 30 cases and 6 cases of glucocorticoid group of hyperlipidemia and high incidence of hypertension (Table 3). Conclusion: Combination of mycophenolate mofetil and low-dose glucocorticoids can effectively relieve allergic purpura nephritis, and its response rate is equivalent to that of full-dose glucocorticoid therapy with less side effects.