吗替麦考酚酯、小剂量激素、拉米夫定联合治疗乙型肝炎病毒相关性肾炎

目的 探讨吗替麦考酚酯、小剂量激素、拉米夫定联合治疗乙型肝炎病毒相关性肾炎的疗效.方法 回顾性总结病理确诊的49例乙型肝炎病毒相关性肾炎患者采用吗替麦考酚酯(≥12岁0.75 g,2次/d,＜12岁0.4 g/m2,2次/d)、拉米夫定(≥12岁100 mg/d,＜12岁3 mg/kg,2次/d)、小剂量激素[泼尼松0.5 mg/(kg·d)]的治疗方案.结果 49例患者中,完全缓解率71.4％(35/49),总有效率81.6％ (40/49),血清中的乙型肝炎病毒DNA平均值从5.43×104拷贝/ml降为＜ 1000拷贝/ml占85.7％(42/49).膜性肾病(MN)完全缓解率为88.0％(22/25),部分缓解率为8.0％(2/25),无效率为4.0％(1/25)；系膜增生性肾小球肾炎(MsPGN)完全缓解率为44.4％(4/9),无效率为55.6％( 5/9)；膜增殖性肾小球肾炎(MPGN)完全缓解率为70.0％(7/10),部分缓解率为30.0％(3/10)；局灶节段肾小球硬化(FSGS)完全缓解率为40.0％(2/5),无效率为60.0％( 3/5).不同病理类型疗效比较差异有统计学意义(P＜0.05).不良反应轻微.结论 吗替麦考酚酯、小剂量激素、拉米夫定联合治疗乙型肝炎病毒相关性肾炎安全有效,其疗效与病理类型有关,MN治疗反应最好,MPGN、MsPGN次之,FSGS较差.

Mycophenolate mofetil combined with low dose of hormone and lamivudine in the treatment of hepatitis B virus associated glomerulonephritis

Objective To assess the efficacy of mycophenolate mofetil (MMF) combined with low dose of hormone and lamivudine in the treatment of hepatitis B virus associated glomerulonephritis (HBV-GN).Methods The clinical data of 49 HBV-GN patients diagnosed by renal pathology was reviewed.They were treated with MMF( ≥ 12 years old,0.75 g,two times a day; ＜ 12 years old,0.4 g/m2,two times a day),low dose of hormone [0.5 mg/(kg·d) ],lamivudine( ≥ 12 years old,100 mg/d; ＜ 12 years old,3 mg/kg,two times a day).Results Among of 49 HBV-GN patients,clinical cure rate was 71.4％(35/49),the total effective rate was 81.6％(40/49),85.7％(42/49) patients' HBV DNA level decreased from 5.43 ×104 copies/ml to ＜ 1000 copies/ml.The complete remission rate was 88.0％ (22/25),the partial remission rate was 8.0％ (2/25),the inefficiency was 4.0％ (1/25) in membranous nephropathy (MN);the complete remission rate was 44.4％ (4/9),the inefficiency was 55.6％ (5/9) in mesangial proliferative glomerulone phritis (MsPGN) ; the complete remission rate was 70.0％(7/10); the partial remission rate was 30.0％(3/10)in membrane proliferative glomerulone phritis (MPGN) ;the complete remission rate was 40.0％ (2/5),the inefficiency was 60.0％(3/5) in focal segmental glomerulosclerosts (FSGS).There was significant difference among the different pathological type (P＜0.05).There were less adverse reactions.Conclusions MMF combined with low dose hormone and lamivudine is safe and effective in treating HBV-GN.The efficacy and pathological type has some relationship,MN has the best response,MPGN and MsPGN are second,FSGS is poor.