Predictive factors analysis of the efficacy of cyclophosphamide combined with glucocorticoids in the treatment of idiopathic membranous nephropathy

Objective To investigate the predictive factors affecting the efficacy of cyclophosphamide (CTX) combined with glucocorticoids in the treatment of idiopathic membranous nephropathy (IMN), and to evaluate the efficacy of calcineurin inhibitor (CNI) adjustment due to poor treatment. Methods A retrospective cohort study was conducted. Two hundreds and twenty-eight patients with IMN diagnosed by renal biopsy in the People's Hospital of Guangxi Zhuang Autonomous Region from January 1, 2007 to December 1, 2016 were enrolled. All subjects were treated with CTX in combination with glucocorticoids. The patients were divided into two groups: remission group and no remission group. Multivariable logistic regression analysis was used to determine the baseline clinical-pathological influencing factors for the remission of IMN in the enrolled patients. Results The number of total remission (including complete and partial remission) of the first CTX combined with glucocorticoid treatment in 228 patients with IMN was 188(82.5%). Among them, 141 patients (61.8%) had complete remission (CR), the median time for CR was 8(6, 12) months, and the median time for partial remission (PR) was 3(1, 4) months. The median follow-up time for this study was 25(13, 43) months. Compared with the remission group, the serum albumin level was lower in the non-remission group, the 24-hour urine protein content, the blood complement C3 and C4 levels were higher, and the pathological stage was milder (all P﹤0.05). Multivariate logistic regression analysis suggested that the levels of baseline serum albumin, complement C4, and pathological stage were independent predictors of clinical remission in IMN patients. Twenty-four non-remission patients were treated with CNI. The overall response rate was 66.7%(16/24) at 6 months and 77.3%(17/22) at 12 months. Conclusions The levels of baseline albumin, blood complement C4, and pathological stage were independent predictors of clinical remission in IMN patients treated with CTX plus glucocorticoids. The non-remission patients with CTX combined with glucocorticoid therapy can still achieve a higher response rate after adjusting for CNI.     

周晋华运用环磷酰胺联合中药紫杉治疗晚期肺癌经验

肺癌多是邪祟之物郁结留滞致使人体气血运行不畅所致,周晋华主任认为肺癌的发生与正虚邪害密不可分,而晚期肿瘤患者虚多实少,全身为虚,当以脾虚为主,“得脾胃者得中央,得中央者得天下”,局部为实,故当以缓治,固脾胃之本培人体之元,周晋华主任运用低剂量规律口服环磷酰胺联合中药紫杉片解毒散结配伍,佐以益气健脾之法治疗晚期肺癌患者,发现对身体基础状况较差的老年肿瘤患者有良好的效果,此法是从姑息性治疗角度运用中西医结合的方法将静脉化疗药环磷酰胺改为口服,在提高老年患者对化疗药物的耐受性,减轻化疗副作用方面有一定的优势,为临床治疗晚期肺癌提供一种新思维。     

环磷酰胺与泼尼松联合治疗狼疮性肾炎的疗效观察

目的：探讨环磷酰胺（ cytoxan，CTX）与泼尼松（ methylprednisolone，MP）联合治疗狼疮性肾炎（ lupus nephritis，LN）的临床疗效与安全性。方法：随机抽取2013年1月—2014年1月于汕头潮南民生医院就诊的LN患者90例，以随机数字表法分为观察组和对照组各45例。观察组患者给予CTX与MP联合治疗，对照组给予MP单药治疗，比较2组患者的临床疗效与安全性。结果：观察组患者的总有效率为93．33％（42／45），显著高于对照组的73．33％（33／45）（P＜0．05）；治疗后，观察组患者的尿蛋白、血沉以及血清肌酐水平均显著低于对照组（P＜0．05），血红蛋白及补体C3水平均显著高于对照组（P＜0．05）；观察组患者不良反应发生率为13．33％（6／45），与对照组的6．67％（3／45）比较，差异无统计学意义（P＞0．05）。结论：CTX与MP联合治疗LN，可改善患者临床症状及肾功能，减少蛋白尿，提高临床疗效，且不良反应较少，值得临床推广。     

Strontium fructose 1, 6‐diphosphate alleviate cyclophosphamide‐induced oligozoospermia by improving antioxidant and inhibiting testicular apoptosis via FAS/FASL pathway

This study investigated the treatment effects of a new compound, strontium fructose 1, 6‐diphosphate (FDP‐Sr), in cyclophosphamide (CP)‐induced oligozoospermia. FDP‐Sr, with extra high‐energy supply, could reverse male hypogonadism in the testis. Male Wistar rats were randomly divided into three groups: control group (vehicle treated), CP group and CP + FDP‐Sr group. Both CP group and CP + FDP‐Sr groups were orally administered CP (20 mg kg^?1) consecutively for the first 7 days to establish CP‐induced testicular toxic models. Subsequently, CP group was given orally distilled water per day, whereas CP + FDP‐Sr group was received FDP‐Sr (200 mg kg^?1) for 49 days. Compared to the CP group, the FDP‐Sr group showed significantly increased levels of serum testosterone, testis relative weights and epididymal sperm counts in rats. In addition, rats treated by FDP‐Sr showed the recuperative activities of testicular marker enzymes and normalised levels of antioxidants in tissue. Testicular protection of FDP‐Sr was further demonstrated by enhancing expression of P450scc, reducing ability of FAS/FASL and generating cytoprotection in the histopathological study. FDP‐Sr appeared to possess an ability to attenuate CP‐induced reproduction toxicity via the activation of antioxidants and steroidogenesis enzymes, and alleviate oligozoospermia via inhibition of testicular apoptosis by FAS/FASL pathway.     

造血干细胞移植预处理诱发口腔黏膜炎模型的建立

目的探讨建立造血干细胞移植预处理诱发口腔黏膜炎大鼠模型的可行性。方法采用马利兰和环磷酰胺预处理方案结合左颊黏膜搔刮建立大鼠口腔黏膜炎模型。设立模型组和对照组，从自然过程、口腔黏膜炎指数、血象、骨髓象、病理检查等指标动态观察口腔黏膜炎的发生、发展过程。结果模型组大鼠于第7天开始出现口腔黏膜炎表现，发生率为80．00％；口腔黏膜炎指数在第11天达到峰值（2．04±1.80），4级以上口腔黏膜炎占39．29％（11／28）；第18～21天病损基本恢复，期间大鼠体重持续下降，白细胞计数于第10天下降至最低点，骨髓增生度低下。结论成功建立了造血干细胞移植预处理诱发口腔黏膜炎的大鼠模型。     

不同剂量环磷酰胺对小鼠免疫功能的影响

目的探索不同剂量环磷酰胺(CTX)对正常小鼠免疫功能的影响,为CTX临床应用提供实验数据。方法 C57BL/6小鼠24只,随机分为对照组、低剂量组和高剂量组,分别给生理盐水(NS)、低剂量和高剂量的CTX,检测血常规、Treg比率、T细胞和B细胞增殖功能及巨噬细胞吞噬功能、细胞增殖周期及凋亡比率。结果 RBC、WBC、PLT数量在高剂量组显著降低,对照组与低剂量组无差异;Treg占CD4+T细胞的比例在低剂量组显著下降,对照组与高剂量组无差异;T、B细胞增殖指数及巨噬细胞吞噬功能在低剂量组高于对照组和高剂量组,高剂量组低于对照组;细胞凋亡比率在高剂量组明显增加,对照组与低剂量组间无差异;高剂量组细胞阻滞在S期,对照组与低剂量组间无差异。结论低剂量CTX通过下调Treg、增强免疫细胞的功能,促进机体免疫;而高剂量CTX通过抑制DNA的复制、促进细胞凋亡和降低免疫细胞功能,使机体处于免疫抑制状态。相关数据可以为CTX的临床应用提供借鉴。     

糖皮质激素和环磷酰胺治疗IgA肾病疗效及相关因素分析

目的 分析糖皮质激素和环磷酰胺治疗IgA肾病患者的疗效,寻找与疗效相关的临床和病理指标.方法 217例IgA肾病患者(尿蛋白定量≥1.0/d,且Scr＜250μmol/L),应用糖皮质激素和环磷酰胺治疗1年后,对比分析治疗有效组和无效组临床及病理资料.将尿蛋白定量＜0.5g/d,或eGFR上升＞15％视为治疗有效.结果 糖皮质激素和环磷酰胺治疗IgA肾病有效者占82.49％,疗效与年龄、肾功能水平、尿蛋白、尿渗透压、肾小管萎缩和肾间质纤维化以及肾小球缺血硬化程度等有关.结论 糖皮质激素和环磷酰胺是治疗IgA肾病有效方法,但选择该方案时,应考虑患者的临床和病理特点.     

泼尼松联合霉酚酸酯对比环磷酰胺治疗狼疮性肾炎的系统评价

目的系统评价泼尼松联合霉酚酸酯与环磷酰胺治疗狼疮性肾炎的疗效及安全性。方法检索Pub Med、MEDLINE、Embase、Cochrance图书馆临床对照试验资料库、中国期刊全文数据库(CNKI)、中文科技期刊全文数据库(维普)和万方数字化期刊全文库等,检索泼尼松联合霉酚酸酯(MMF)与环磷酰胺(CTX)治疗狼疮性肾炎的随机对照临床试验(检索时间均从建库至2013年12月),对完全缓解率、部分缓解率、总缓解率、感染、白细胞减少、胃肠道反应进行Meta分析。结果共纳入22篇文献(共1 641例),Meta分析结果显示,与泼尼松+CTX组比较,泼尼松+MMF组的完全缓解率及总缓解率高(P<0.01),而感染率、白细胞减少发生率低(P<0.01),两组间部分缓解率及胃肠道反应比较差异无统计学意义(P>0.05)。结论泼尼松联合MMF治疗狼疮性肾炎的缓解率较泼尼松联合CTX高,感染及白细胞减少的风险较小。