64例狼疮性肾炎大剂量环磷酰胺冲击治疗的研究

目的　观察大剂量环磷酰胺冲击治疗狼疮性肾炎的疗效。方法　对 6 4例狼疮肾炎 ( L N ,其尿红细胞 >10个 /高倍视野 ,2 4小时尿蛋白 >1g,血肌酐 >133μmol/ L )进行大剂量环磷酰胺 ( CTX)冲击治疗 (每月 1次 ,共 6次 ,其后每 3月 1次 ,共 6次 )。结果　 49例 L N患者达到肾脏损害缓解 ( 2 4小时尿蛋白 <1g;血肌酐 <133μmol/ L ;尿沉渣内红细胞 <10个 /高倍视野 ;尿管型消失 )。达到肾脏病变缓解所需冲击次数平均为 3.6次 ( 1～8次 )。每次用 CTX剂量均数 1.1g( 0 .6～ 1.6 g)。副作用有闭经 (发生率 33% ) ;带状疱疹 (发生率 13% ) ;出血性膀胱炎 1例。结论　此治疗方案治疗 L N有效 ,安全 ,副作用小

Study on Bolus Cyclosphamide Treament for 64 Cases of Lupus Nephritis

Objective To report on the dosing, efficacy and s ide-effects ofbolus cyclosphamide treatment for lupus nephritis (LN). Methods 64 consecuti ve cases of LN with 10 or more erythrocytes per high -power field, proteinuri a (>1g of protein per day ) and serum creatinine increased (>133μmol/L) were tre ated by bolus therapy with cyclophosphamide (CTX) given monthly for 6 months and then quarterly for 18 months. Results 49 patients had renal remission (defin ed as <10 erythrocytes per high-power field, absence of cellular casts, excreti o n of <1g of protein per day and normal serum creatinine). The mean of doses was 1.1g for each time (0.6-1.6g ), the mean of times of bolus CTX needed was 3.6 (1 -8 times). The adverse events were amenorrhea (in 41% female patients), herpes z oster (in 13% patients ) and hemorrhagic cystitis (in 1 patient). Conclu sion The results indicate that monthly bolus CTX therapy is effective and safe for patients with LN. Its adverse effect is relatively not a serious p roblem.