霉酚酸酯与环磷酰胺治疗难治性肾病综合征的对照观察

目的比较霉酚酸酯（MMF）和间断环磷酰胺（CTX）静脉疗法对难治性肾病综合征的疗效及安全性。方法将2000年1月至2007年10月间在我院诊断的30例难治性肾病综合征患者分为激素联合MMF治疗组（MMF组，n=14）、激素联合CTX间断静脉冲击治疗组（CTX组，n=16）。MMF剂量1．5～2．0g／d，CTX剂量0．75～1．00g／m^2，每个月1次，共6次，每3个月1次，共2次。比较2组治疗12个月的临床缓解率和相关临床指标变化。结果①2组治疗后尿蛋白、血脂水平明显下降，血清白蛋白显著上升，血肌酐无明显改变。②治疗6和12个月时MMF组总缓解率高于CTX组。③不良反应：MMF组并发带状疱疹和白细胞减少各1例，CTX组有2例出现明显消化道症状，2组各有1例并发带状疱疹、细菌性肺炎、白细胞下降、天冬酸氨基转移酶升高、脱发。结论激素联合MMF治疗难治性肾病综合征缓解率高于CTX静脉冲击疗法，能更有效改善蛋白尿。MMF不良反应发生率低于CTX疗法。

A randomized control trial of cyclophosphamide vs mycophenolate mofeil in the treatment of refractory nephropathy syndrome

Objective To investigate the effectiveness and safety of cyclophosphamide（CTX） vs mycophenolate mofeil（MMF） in the treatment of refractory nephropathy syndrome. Method Thirty patients with refractory nephropathy syndrome were divided into MMF and CTX groups. MMF group included 14 cases who were treated with MMF at a dosage of 1. 542. 0 g/d monthly for 6 months,and CTX group enrolled 16 cases who were given 0. 75 - 1.00 g/m^2 RSA, once every 3 months for 6 months. The patients in both groups also received oral predenisone A series of experimental data were observed before and 12 months after treatment. Result @In both groups the proteinufia was decreased significantly, and serum albumin increased significantly. （2）The total remission rate at the 6th and 12th month after MMF therapy was 35. 7% and 78. 6% ,and only 31.2% and 62. 5% respectively in CTX group. （~The side effects included herpes zoster （one case） and leukocytopenia （one case） in the MMF group, and gastrointestinal symptoms（2 cases）, pneu- monia（one case）, leukocytopenia（one case）, transient hepatic malfunction（one case） and alopecie（one case） in the CTX group. Conclusion Higher clinical remission rate and less complications were observed in refractory nephropathy syndrome patients who received MMF induction regime than in those who received intravenous pulse CTX regime.