新型免疫抑制剂霉酚酸酯治疗狼疮性肾炎

目的观察新型免疫抑制剂霉酚酸酯(M.MF)治疗狼疮性肾炎的临床疗效和安全性。方法经肾活检证实的20例狼疮性肾炎，给予糖皮质激素联合MMF治疗。MMF初始剂量1.0～1.5g/d，治疗时间321个月，平均(10.9±6.2)个月。结果MMF治疗后24h尿蛋白定量从治疗前的平均5.55g下降至1.54g；d清白蛋白治疗前平均26.87g升至39g；6/8例肾功能不全患者3个月内Scr恢复正常；d清自身抗体产生明显减少，补体上升，其中ANA转阴率3个月达63％，6个月达81％；抗ds-DNA由治疗前23.77IU／ml下降至9.19IU／ml；2例重复活检，肾小球活动性病变明显减轻。MMF治疗的不良反应较少，偶有白细胞减少、感染、带状疱疹等。结论MMF对于各型狼疮性肾炎，尤其是Ⅳ型重症狼疮，经传统治疗无效者均有较好疗效，且长期应用不良反应少。

Evaluation of the efficacy of mycophenolate mofetil treatment in lupus nephritis

Objective To investigate the efficacy and safety of mycophenolate mofetil (MMF) treatment of lupus nephritis. Method 20 patients with lupus nephritis confirmed by renal biopsy were treated by combined prednisone and MMF therapy. Results The initial dosage of MMF was 1.0～ 1.5 g/d. The treatment duration was 10.9+ 6.2 months (range 3～21 months). After treatment, 24 hours urinary protein excretion decreased from 5.55 g to1.54 g, serum albumin increased from 26.87 g/L to 39 g/L. 6 of 8 patients with renal insufficiency. The serum creatinine fell to normal. Serum autoimmune antibodies reduced significantly, while complements were increased. Negativeconversion rate of ANA was 63% within 3 months and 81% in 6 months,the anti-ds-DNA antibody reduced from 23.77IU/ml to 9.19IU/ml. Two patients underwent a second biopsy , the glomerula activity index improved significantly. The side effects of MMF were uncommon, leukopenia, infection and herpes zoster were seldom observed. Conclusion MMF can be used in lupus nephritis, especially in type IV, and in patients refractory to other convensional treatment regimes. There is no severe adverse effect with long-term treatment. (Shanghai Med J, 2000,24:81-84)