霉酚酸酯对弥漫增生型狼疮性肾炎患者的疗效观察

目的 :比较霉酚酸酯 (MMF)和环磷酰胺 (CTX)冲击疗法治疗Ⅳ型狼疮性肾炎的疗效及不良反应。方法 :A组 2 0例 ,间断性CTX冲击疗法联合激素 1mg·kg-1·d-1治疗 ;B组 2 0例 ,MMF联合激素治疗。随访 12个月。结果 :CTX组、MMF组治疗LN均能降低蛋白尿、血尿 ,改善肾功能和免疫指标 ,两组无统计学意义 (P >0 .0 5 ) ,但MMF组治疗效果优于CTX组。不良反应 ,MMF组明显低于CTX组 (P <0 .0 5 )。结论 :CTX、MMF都能有效地控制狼疮性肾炎 ,且MMF具有一定的优越性     

不同治疗方案应用于IgA肾病患者中的效果分析

目的研究不同西医方案治疗IgA肾病患者的临床疗效以及安全性。方法以2016年1月至2018年6月于高州市人民医院接受治疗的72例IgA肾病患者作为研究对象。将其按照随机数字表法均分成环磷酰胺组、霉酚酸酯组以及对照组,每组各24例。对照组予以单纯糖皮质激素治疗,环磷酰胺组予以糖皮质激素联合环磷酰胺治疗,霉酚酸酯组则采用糖皮质激素联合霉酚酸酯治疗。3组患者均治疗6个月,比较3组临床疗效、治疗前后各项生化指标水平以及不良反应发生情况。结果环磷酰胺组、霉酚酸酯组、对照组不同Haas分型患者的临床治疗总有效率之间无显著差异(均P0.05)。治疗后环磷酰胺组、霉酚酸酯组患者24 h尿蛋白定量、血肌酐、血清尿素、血尿酸均显著低于对照组(均P0.05);而环磷酰胺组、霉酚酸酯组上述指标水平对比无明显差异(均P0.05)。霉酚酸酯组不良反应发生率为0.00%(0/24),相比环磷酰胺组16.67%(4/24)以及对照组25.00%(6/24)均较低(均P0.05)。结论糖皮质激素联合环磷酰胺以及糖皮质激素联合霉酚酸酯治疗IgA肾病患者的临床疗效相当,但后者不良反应发生率较低,具有更好的安全性,值得临床推广应用。     

霉酚酸酯治疗系统性红斑狼疮的临床观察

免疫抑制剂在系统性红斑狼疮 (SLE)及狼疮性肾炎(LN)中的应用 ,目前受到人们的重视。有关霉酚酸酯(MMF)及环磷酰胺 (CTX)冲击治疗重症狼疮及狼疮性肾炎的研究越来越多 ,而对于霉酚酸酯 (MMF)与环磷酰胺冲击治疗的对比报道较少 ,现将我们使用MMF与CTX治疗SLE的对比观察报道如下。资料与方法1　一般资料　 2 8例SLE患者均符合 1982年美国风湿病协会SLE诊断标准 ,为我院 1993年～ 2 0 0 1年住院及门诊病人 ,其中MMF组均为 1999年～ 2 0 0 1年的患者 ,CTX组为 1993年～ 2 0 0 1年患者。MMF组 12例 ,女 11例 ,男 1例 ,年龄 16岁…     

霉酚酸酯治疗肾小球疾病并发肺部感染的防治策略

霉酚酸酯（ mycophenolate mofetil,MMF）是一种临床常用的免疫抑制剂,在肾脏病领域用于狼疮性肾炎合并血管病变、紫癜性肾炎和抗中性粒细胞胞浆抗体（ ANCA ）相关血管炎等肾脏病的治疗。国内外大量的临床对照性研究证明MMF治疗狼疮性肾炎（ LN）的缓解率显著高于环磷酰胺。 MMF最常见的不良反应是胃肠道反应如腹泻、恶心腹胀等,但MMF最严重的并发症仍是感染。     

狼疮方对狼疮性肾炎活动性和血中透明质酸的作用

目的:探讨狼疮方对狼疮性肾炎(LN)活动性和血中透明质酸(HA)的作用.方法:60例LN患者随机分为治疗组(狼疮方)和对照组(单纯西药组)治疗,观察两组治疗前后狼疮活动度和血中HA(放射免疫法),并设30例慢性肾小球肾炎(CGN)作对照.结果:两组LN患者治疗前HA明显高于CGN组(P＜0.01)且与狼疮活动度呈明显正相关(P＜0.01),而三组Scr无明显异常.治疗后两组狼疮活动度、HA均有不同程度的改善,而治疗组总有效率(91.81%)优于对照组(69.66%).结论:血中HA可作为LN活动的重要指标,狼疮方能降低LN血中HA和减少狼疮活动性.     

霉酚酸酯治疗重症狼疮性肾炎疗效观察

狼疮性肾炎(LN)是继发性肾脏病导致终末期肾衰竭的最常见病因.根据中山大学附属第一医院肾内科肾穿刺病理活检资料,LN占继发性肾小球疾病的81%.其病理改变以细胞外基质的积聚、肾小球、肾小管、血管及间质的损害为特征.多年来,由于糖皮质激素及细胞毒药物的联合应用,其肾脏的生存率有了显著提高,但是长期应用大剂量环磷酰胺(CTX),毒副作用大,继发感染,使原发病加重,是死亡的重要原因.对于重症及难治性LN的治疗,如何在初始阶段的个体化治疗中,取得最大的疗效和最小的副作用,新型免疫抑制剂霉酚酸酯(MMF)对治疗难治性、重症LN疗效佳,副作用小,近期已被临床重视及选用.近年来我们应用霉酚酸酯(MMF)治疗LN患者36例,并与环磷酰胺(CTX)治疗的32例患者对照,现将结果报告如下.     

霉酚酸酯治疗狼疮性肾炎伴血管病变患者血管内皮细胞损伤标记物的变化

目的 观察霉酚酸酯(MMF)治疗Ⅳ型狼疮性肾炎(LN)伴血管病变过程中,循环内皮细胞(CECs)、E-选择素(E-selectin)、血栓调节蛋白(TM)和血管内皮细胞黏附分子-1(VCAM-1)的变化,以期寻找无创的、反映MMF疗效的特异性分子标记物指导其治疗.方法 8例经肾活检诊断为Ⅳ型LN伴肾间质非炎症坏死性血管...     

霉酚酸酯治疗难治性狼疮性肾炎合并急性肾衰竭

为了观察新型免疫抑制剂霉酚酸酯(MMF)治疗难治性狼疮性肾炎(LN)合并急性肾衰竭的疗效和副作用，笔对传统免疫抑制剂无效的6例LN合并急性肾衰竭患，改用MMF治疗，兹报道如下。     

狼疮性肾炎分型分阶段中西医结合治疗

系统性红斑狼疮 (SLE)是我国最常见的风湿病之一 ,发病率约占 70例 /10万人口。SLE伴肾脏损害占 70 %以上 ,而病理检查几乎 10 0 %有肾脏损害。狼疮性肾炎 (LN)占我国继发性肾炎的第一位。LN的治疗近年来取得了重大进展 ,10年存活率已提高到 90 %以上。糖皮质激素及免疫抑制剂仍然是LN的首选药物 ,特别是美国国立卫生研究院(NIH)提倡的大剂量糖皮质激素联合环磷酰胺 (CTX)冲击方案使许多重型LN获得缓解。新的免疫抑制剂如环孢霉素A(CsA)及霉酚酸酯 (MMF)的问世又使部分难治性LN获得缓解。尽管如此 ,仍有许多问题未能解决 ,肾衰…     

腹膜透析配合WS—健肾频谱仪及药物治疗重症狼疮性肾炎

我科应用腹膜透析配合WS-健肾频谱仪及药物治疗重症狼疮性肾炎(LN)3例,疗效满意,报道如下。 例1,女,43岁,因反复低热、关节酸痛、面部红斑、浮肿7月伴少尿,大量腹水2月入院。Hb50g/L,尿蛋白6.1g/24h,A/G=18/27,BUN37.3mmol/L,Scr339.7umol/L,ANA1:640,C_3<2.3mg/L,C_4<1.1mg/L,抗dsDNA抗体阳性。肾活检病理诊断:WHOⅣ型。LN活动指数(AI)8分,慢性指数(CI)4分。经甲基强的松龙1g静滴3天,环磷酰胺(CTX)0.6静滴每月一次,尿激酶2万U加肝素50mg静滴2周,强的松、雷公藤维持治疗。WS-健肾频谱仪(病人坐     

霉酚酸酯治疗弥漫增生性狼疮肾炎的临床观察

目的 :评估霉酚酸酯联合强的松治疗弥漫增生性狼疮肾炎的疗效及其安全性。方法 :4 6例患者随机分成 2组 ,治疗组口服霉酚酸酯加强的松 12个月 ;对照组静滴环磷酰胺加口服强的松 6个月 ,之后给予强的松和硫唑嘌呤 6个月。结果 :治疗组的 2 5个病人中的 80 %完全缓解 ,对照组中 76 %完全缓解 ,而治疗组、对照组病人部分缓解率分别为 17%和 14 %。每组各有 1个病人因副作用中断治疗 ,治疗过程中治疗组有 2 0 % ,对照组有 33%病人出现感染 (P =0 .2 9)。同时观察到仅对照组病人中出现闭经 (占病人中的 2 3% )、脱发 (19% )、白细胞减少 (10 % )及死亡(10 % )等副反应。治疗组、对照组复发率分别为 13%和 11%。结论 :对于弥漫增生性狼疮肾炎的治疗 ,霉酚酸酯和强的松联合治疗的方案与环磷酰胺和强的松治疗后序贯使用硫唑嘌呤的方案效果相同 ,而前者的副作用较少     

补肾活血汤联合前列地尔对老年糖尿病肾病患者血液流变学及肾功能的影响

目的 探讨补肾活血汤联合前列地尔对老年糖尿病肾病（DN）患者血液流变学及肾功能的影响。方法 选取2017年1月至2019年1月本院收治的老年DN患者160例,依据随机数字表将其分为对照组和观察组,每组80例。对照组给予前列地尔治疗,观察组在对照组的基础上给予补肾活血汤联合治疗。比较两组患者的血糖控制效果[空腹血糖（FBG）、糖化血红蛋白（HbAlc）、餐后2 h血糖（2hPBG）]、血液流变学指标[血小板聚集率（PAR）及低切、中切、高切全血黏度（BV）]、肾功能指标[血肌酐（Scr）、血尿素氮（BUN）、24 h尿微量白蛋白定量（24hUPRO）]、治疗疗效及不良反应。结果 两组治疗后的FBG、HbAlc、2hPBG、Scr、BUN、24hUPRO、PAR及低切、中切、高切BV明显低于治疗前（P<0.05）。观察组治疗后的FBG、HbAlc、2hPBG、Scr、BUN、24hUPRO、PAR及低切、中切、高切BV均明显低于对照组,差异有统计学意义（P<0.05）。观察组的治疗有效率97.50（78/80）高于对照组87.50%（70/80）（P<0.05）。两组的不良反应发生率比较,差异无统计学意义[10.00%（8/80） vs. 7.50%（6/80）,P>0.05]。结论 补肾活血汤联合前列地尔治疗可有效改善老年DN患者的血糖控制效果、血液流变学及肾功能指标,可提高治疗疗效,且安全性好,值得临床推广。     

Randomized controlled trial of pulse intravenous cyclophosphamide versus mycophenolate mofetil in the induction therapy of proliferative lupus nephritis

Background: The aim of the present study was to evaluate the efficacy of mycophenolate mofetil in the induction therapy of proliferative lupus nephritis. Methods: Forty‐four patients from eight centres with newly diagnosed lupus nephritis World Health Organization class III or IV were randomly assigned to either mycophenolate mofetil (MMF) 2 g/day for 6 months or intravenous cyclophosphamide (IVC) 0.75–1 g/m² monthly for 6 months in addition to corticosteroids. Results: Remission occurred in 13 out of 25 patients (52%) in the IVC group and 11 out of 19 patients (58%) in the MMF group (P = 0.70). There were 12% in the IVC group and 26% in the MMF group that achieved complete remission (P = 0.22). Improvements in haemoglobin, the erythrocyte sedimentation rate, serum albumin, serum complement, proteinuria, urinary activity, renal function and the Systemic Lupus Erythematosus Disease Activity Index score were similar in both groups. Twenty‐four follow‐up renal biopsies at the end of therapy showed a significant reduction in the activity score in both groups. The chronicity index increased in both groups but was only significant in the IVC group. Adverse events were similar. Major infections occurred in three patients in each group. There was no difference in gastrointestinal side‐effects. Conclusions: MMF in combination with corticosteroids is an effective induction therapy for moderately severe proliferative lupus nephritis.     

Mycophenolate mofetil therapy for children with lupus nephritis refractory to both intravenous cyclosphosphamide and cyclosporine

We describe mycophenolate mofetil (MMF), a new immunosuppressive agent, to be a therapy of two children with lupus nephritis which were refractory to both cyclophosphamide (CyP) and cyclosporine (CsA). After 11- to 12-month course of MMF treatment, all clinical symptoms of lupus disappeared and serum antibodies became negative. MMF might be a promising curative for cyclophosphamide-resistant lupus nephritis in children. Cyclophosphamide intravenous bolus therapy is generally considered to be the treatment for patients with lupus nephritis. However, there is little guidance about what to do if such therapy fails. Recently, a new immunosuppressive agent, mycophenolate mofetil (MMF), has been used to treat cyclophosphamide-resistant lupus nephritis [Dooley et al. 1999, Gaubitz et al. 1999, Glicklich and Acharga 1998] in adults and has been recognized as a promising curative for lupus nephritis. Up to now, MMF has been adopted widely with solid organ transplantation to prevent or reverse acute rejection [Mathew 1998, Morris-Stiff and Jurewicz 1998] and has been used successfully to treat for rheumatoid arthritis refractory to a variety of other drugs. But there is no report about MMF treatment in children with cyclophosphamide-resistant lupus nephritis. We describe our experience with MMF treatment in two Chinese children with lupus nephritis that were refractory not only to cyclophosphamide but also to cyclosporine.     

中医疗法联合血液净化在急性肾功能衰竭患者中的应用效果

目的 探讨中医联合血液净化疗法对急性肾功能衰竭(ARF)患者的疗效.方法 选取于本院就诊的ARF患者86例,随机数字表法分为观察组和对照组,每组43例.两组患者均接受血液净化疗法治疗.观察组在此基础上给予中药治疗.统计两组治疗前、治疗后3 d内24 h尿量(UV)、尿素氮(BUN)、血肌酐(Scr)水平;BUN和Scr治疗后恢复正常时间以及尿蛋白转阴时间,并进行疗效评价.结果 观察组和对照组治疗总有效率分别为93.02%(40/43)和81.39%(25/43),两组比较差异存在统计学意义(P<0.05).肾毒性急性肾衰患者和缺血性急性肾衰患者总有效率分别为92.85%(26/28)和93.33%(14/15),两组比较差异无统计学意义(P>0.05).治疗前两组24 h UV比较差异无统计学意义(P>0.05),治疗1 d、2 d和3 d两组24 h UV比较差异无统计学意义(P>0.05).观察组尿蛋白转阴时间、Scr恢复正常时间和BUN恢复正常均显著低于对照组(P<0.05).结论 中医联合血液透析治疗ARF疗效显著,能缩短肾功能恢复时间,值得临床推荐.     

肾移植术后早期主动减少免疫抑制剂用量的前瞻性研究

目的探讨对肾移植术后受者早期主动减少免疫抑制剂用量的临床必要性和安全性。方法随机选择63例尸体肾移植受者为观察组,58例尸体肾移植受者为对照组,两组受者均采用环孢素(CsA)+麦考酚吗乙酯(MMF)+泼尼松三联免疫抑制方案。于术后第6周对观察组63例受者予以主动减少免疫抑制剂用量(将CsA血药谷浓度维持在200～250 ng/ml,MMF按受者体质量主动减药),术后4～6个月开始按个体状况将MMF用量调至减药前水平。对照组按常规免疫抑制方案治疗。观察两组受者术后6周至1年的血清肌酐(Scr)、血尿素氮(BUN)、CsA血药谷浓度、肺部感染发生率、急性排斥反应(AR)发生率。结果随访1年期间,观察组受者Scr、BUN基本稳定在同一水平,且与对照组比较差异无统计学意义(均为P>0.05)。观察组与对照组的AR发生率分别为8%与9%,比较差异无统计学意义(P>0.05)。两组的肺部感染率分别为8%(5/63)和14%(8/58),比较差异有统计学意义(P<0.05),对照组有2例发展为严重的肺部感染。结论肾移植术后早期主动减少免疫抑制剂用量能有效降低此阶段肺部感染发生率,且AR发生率并没有增加。     

Is mycophenolate mofetil superior to pulse intravenous cyclophosphamide for induction therapy of proliferative lupus nephritis in Egyptian patients?

Background  

Recent studies have suggested that mycophenolate mofetil (MMF) may offer advantages over intravenous cyclophosphamide (IVC) for the treatment of lupus nephritis. The aim of this study was to evaluate the efficacy of MMF compared with IVC in the induction therapy of proliferative lupus nephritis.     

Successful treatment of class V+IV lupus nephritis with multitarget therapy

Treatment of class V+IV lupus nephritis remains unsatisfactory despite the progress made in the treatment of diffuse proliferative lupus nephritis. In this prospective study, 40 patients with class V+IV lupus nephritis were randomly assigned to induction therapy with mycophenolate mofetil, tacrolimus, and steroids (multitarget therapy) or intravenous cyclophosphamide (IVCY). Patients were treated for 6 mo unless complete remission was not achieved, in which case treatment was extended to 9 mo. An intention-to-treat analysis revealed a higher rate of complete remission with multitarget therapy at both 6 and 9 mo (50 and 65%, respectively) than with IVCY (5 and 15%, respectively). At 6 mo, eight (40%) patients in each group experienced partial remission, and at 9 mo, six (30%) patients receiving multitarget therapy and eight (40%) patients receiving IVCY experienced partial remission. There were no deaths during this study. Most adverse events were less frequent in the multitarget therapy group. Calcineurin inhibitor nephrotoxicity was not observed, but three patients developed new-onset hypertension with multitarget therapy. In conclusion, multitarget therapy is superior to IVCY for inducing complete remission of class V+IV lupus nephritis and is well tolerated.     

Novel therapies of lupus nephritis

PURPOSE OF REVIEW: To review the results of the current therapy of lupus nephritis, highlighting successes and pitfalls, and summarizing the evidence available on the new agents RECENT FINDINGS: The established treatment of lupus nephritis with aggressive immunosuppression, based on cyclophosphamide and steroids, has improved the outcome of lupus nephritis, but is burdened with significant adverse effects. The search for alternative, less toxic, therapeutic strategies has prompted a number of clinical studies, mycophenolate mofetil being the agent most studied. Results of trials showed that this drug is equally effective with fewer toxic complications than standard therapy, but its long-term efficacy is not yet known. During the last few years experimental studies in the pathogenesis of lupus nephritis have provided an enormous improvement in our knowledge and have offered the possibility to attempt targeting the disease with a more selective approach. The evidence for the role of these new therapies is reviewed. SUMMARY: While the current alternative to standard therapy, i.e. mycophenolate mofetil, still needs to be confirmed with well designed, properly powered studies, new therapeutic agents, targeted to the pathogenetic mechanism of the disease, are promising improved efficacy with less toxicity.     

Efficacy of low-dose leflunomide in lupus nephritis: A multi-center prospective study

Objective To investigate the efficacy of leflunomide combined with prednisone in the induction therapy of proliferative lupus nephritis (LN). Methods A prospective, multicenter, randomized controlled clinical trial was conducted in patients with biopsy-proved proliferative lupus nephritis recruited from 15 renal centers from 2013 to 2015. Patients were randomized to two groups. Oral leflunomide or intravenous cyclophosphamide was given to patients in each group. Both groups received a tapering course of oral prednisone therapy. All patients were followed up for 24 weeks. The blood biochemistry, urine index, clinical curative effect and adverse reaction were recorded and analyzed statistically. Results A total of 100 patients were enrolled in this clinical trial, including 48 patients in leflunomide group and 52 patients in cyclophosphamide group. After 24 weeks, the overall response rate was 79% (95%CI 67%-90%) in the leflunomide group and 69% (95%CI 56%-82%) in the cyclophosphamide group. 23% (95%CI 11%-35%) of patients in leflunomide group showed complete remission compared with 27% (95%CI 24%-30%) in cyclophosphamide group (P=0.35). The levels of 24-hr urine protein excretion, SLEDAI and anti-dsDNA antibody titers were decreased in patients treated with leflunomide group after 24-weeks treatment. And the levels of serum albumin and complement 3 after treatment were significantly higher compared with these before treatment. There was also no significant difference in changes of 24-hr urine protein excretion, SLEDAI score, anti-dsDNA antibody titers, serum albumin and complement C3 levels after treatment between two groups. Incidence of adverse events did not differ between the leflunomide and cyclophosphamide group. Conclusions Leflunomide combined with prednisone showed same efficacy compared with cyclophosphamide as induction therapy for lupus nephritis. Leflunomide might be an useful medicine in the induction therapy of lupus nephritis.