吗替麦考酚酯治疗难治性肾病综合征的疗效观察

目的：探讨吗替麦考酚酯（MMF）治疗激素抵抗肾病综合征的疗效。方法：选择本院确诊为肾病综合征患者24例，经强的松1mg·kg^-1·d^-1 8周以上疗效不佳或复发的患者，其中个别患者还经过环磷酰胺或环孢霉素A治疗。所有患者均采用MMF联合小剂量激素治疗，MMF起始剂量为1．0～1．5g／d，至少3个月后开始减量，维持量在0．5～1．0g／d，强的松剂量5—20mg／d，随访时间≥6个月，主要观察治疗前后尿蛋白、血清白蛋白、肝功能、肾功能等的变化。结果：患者治疗后尿蛋白由治疗前（3．4±1．7）g／d降至（0．9±0．2）g／d，血清白蛋白由治疗前（19．6±5．4）g／L增至（36．1±7．7）g／L，血肌酐由治疗前（105．7±6．4）umol／L降至（90．1±5．8）umol／L。20例（83．3％）患者病情缓解，其中完全缓解15例（65．2％），部分缓解5例（20．8％），无反应4例（16．6％）。副作用：胃肠适症状8例（33．3％），细菌性肺炎4例（16．6％），带状疱疹1例（4．1％），轻度肝酶升高3例（12．5％）。结论：MMF联合小剂量激素治疗激素抵抗肾病综合征是有效和安全的，可成为难治性肾病综合征（refractory nephrotic syndrome，RNS）的治疗选择。

Therapeutic effects of mycophenolate mofetil in refractory nephrotic syndrome

AIM: To approach the therapeutic effects of mycophenolate mofetil (MMF)in hormonal resistance nephrotic syndromes. METHODS: Patients were diagnosed as nephrotic syndrome and treated with prednisone at the dose of 1 mg·kg~(-1)·d~(-1) for over 8 weeks, and 24 patients with unsatisfactory results or were palindromic were selected, and several patients in the 24 patients had been treated with cyclophosphamide or cyclosporine A. All patients were treated with MMF combined with low dose hormone. The initial dose of MMF was 1.0- 1.5 g/d for 3 months, later the dose were reduced, and the maintenance dose of MMF was 0.5 - 1.0 g/d, the dose of prednisone was 5-20 mg/d,the follow-up visit period more than six months. The changes on urine protein, serum albumin, liver function, renal function were compared before and after treatment. RESULTS: Before and after treatment, urine protein decreased from(3.4 ± 1.7) g/d to(0.9 ± 0.2) g/d,serum albumin increased from(19.6 ± 5.4) g/L to (36.1 ± 7.7) g/L. Serum creatinine level decreased from(105.7 ± 6.4) μmol/L to(90.1 ± 5.8) g/L. 20 patients(83.3%) pathogenetic condition were relieved, 15 patients(65.2%) were with complete remission. 5 patients (20.8%) were partially recovered, and 4 patients (16.6%) had no response. The adverse effects were observed, including gastrointestinal events ( n = 8, 33.3% ) , bacterial pneumonia ( n = 4, 16.6%), herpes zoster (n - 1, 4.1%), hepatic function mild damage( n = 3, 12.5% ). CONCLUSION: It is safe and effective to combine MMF with low dose hormone in treatment of hormonal resistance nephrotic syndrome, which could become a therapeutic option for refractory nephrotic syndrome ( RNS) .