环孢霉素A与环磷酰胺治疗难治性肾病的疗效比较

目的比较环孢霉素A(CSA)与环磷酰胺(CTX)联合激素治疗难治性肾病的疗效和安全性。方法将152例难治性肾病综合征患者随机分两组分别予CSA联用糖皮质激素治疗(CSA组)或CTX联用糖皮质激素治疗(CTX组),疗程至少12个月,观察各组的24 h尿蛋白定量、血浆白蛋白、肾功能、血糖、白细胞总数及其不良反应,以及治疗前后的完全缓解率、部分缓解率。结果两组患者各项指标均较治疗前好转。治疗6个月末,CsA组的24 h尿蛋白、胆固醇、三酰甘油显著低于CTX组(P均<0.01),血清白蛋白显著高于CTX组(P<0.01),两组患者的血肌酐比较差异无统计学意义(P>0.05),而CTX组的WBC显著低于CsA组(P<0.01)。CsA组完全缓解率显著高于CTX组(χ2=4.5690,P<0.05),治疗12个月末两组的完全缓解率差异无统计学意义(χ2=1.2306,P>0.05)。结论与CTX相比,CsA联用糖皮质激素对治疗12个月的总体疗效相当,但CsA起效更快,近期疗效更好,不良反应更小。

Comparison on the Therapeutic Effect of Cyclosporin A and Cyclophosphamide in the Treatment of Refractory Nephropathy Syndrome

Objective To compare the efficacy and safety of cyclosporin A （CSA） and cyclophosphamide （CTX） combined hormone in the treatment of Refractory Nephropathy Syndrome（RNS）.Methods 152 patients with Refractory Nephropathy Syndrome ,were randomly divided into two groups to CSA combined with glucocortieoid treatment （ CSA group） or CTX combined with glucoeorticoid treatment （CTX group）, treatment for at least 12 months. To observe 24 h urinary protein, serum albumin, renal function, blood glucose, WBC and its side effects in each group, and complete response rates before and after treatment, partial remission rate. Results Treatment after 6 months, CsA group, 24 hours urine protein, cholesterol, triglycerides were significantly lower than the CTX group （P all〈0.01）, serum albumin was significantly higher than the CTX group （P〈0.01）.Comparison of two groups of serum creatinine in patients with no significant difference （P〉0.05）, while the CTX group, WBC was significantly lower than CsA group （P〈0.01）. CsA complete remission rate was significantly higher than that of CTX group （x2= 4.5690, P〈0.05）. The end of the treatment of 12 complete remission rate in both groups no significant difference （x2=1.2306,/〉〉0.05）. Conclusion Compared with CTX, CsA combined with glucocorticoid treatment for 12 months on the RNS overall efficacy equivalent, but CsA faster onset, better curative effect, less adverse reactions.