两种方案治疗特发性膜性肾病的疗效比较

目的：比较小剂量激素联合环孢素A（ CsA）与足量糖皮质激素联合环磷酰胺（ CTX）两种方案治疗特发性膜性肾病（ IMN）的疗效及安全性。方法将42例IMN患者按照数字表法随机分为A组和B组，每组21例。在相同的基础治疗上，A组给予足量糖皮质激素联合CTX治疗，B组予小剂量激素联合CsA治疗。检测比较两组治疗前、治疗3个月、6个月、12个月的24 h尿蛋白定量（24 h Upro）、血肌酐（ CR）、谷氨酸氨基转移酶（ ALT）、血白蛋白（ ALB）、血糖（ GLU）等指标，比较两组完全缓解率、部分缓解率、复发率及不良反应。结果治疗前两组各指标差异均无统计学意义（均P＞0．05），其中A组24 h Upro（5．3±2．1）g/L，ALB （21．8±8．1）g/L，B组24 h Upro（5．4±2．3）g/L，ALB（20．3±7．5）g/L；治疗3个月时，两组24 h Upro均显著下降，ALB显著升高，A组24 h Upro（3．2±1．2） g/L，ALB（27．9±7．6） g/L，B组24 h Upro（3．5±1．3） g/L， ALB（26．4±8．1）g/L，两组24 h Upro均呈逐渐下降趋势（F＝5．216，P＜0．05），ALB呈逐渐上升趋势（F＝5.864，P＜0．05）。在不同时间点，两组总缓解率差异均无统计学意义（P＞0．05）。 A组复发率9.5％，B组复发率14．3％，两组差异亦无统计学意义（P＞0．05）。 A组不良反应发生率为23．8％，B组不良反应发生率为28．6％，两组差异无统计学意义（P＞0．05）。结论激素联合CTX与激素联合CsA两种方案对IMN的疗效相近，临床治疗中，可结合患者的具体情况，制定个体化的治疗方案。

Comparison of the effects of two therapeutic regimen in the treatment of idiopathic membranous nephropathy

Objective To compare the clinical efficacy and safety between cyclosporine A combined with low-dose hormone and progestin hormone combined cyclophosphamide（ CTX） in the treatment of idiopathic membra-nous nephropathy（ IMN） .Methods 42 patients with IMN were randomly divided into group A and group B according to a random number table,21 cases in each group.On the same basic treatment,group A was given adequate glucocor-ticoid and CTX therapy,group B was given small doses of hormones combined with CsA.24hUpro,CR,ALT,ALB and GLU of the two groups at before treatment and 3 months,6 months,12 months after treatment were compared.And the complete remission rate,partial remission rate, relapse rate and adverse reactions in the two groups were also com-pared.Results The indicators of the two groups before treatment showed no significant difference,and 24hUpro of group A was （5.3 ±2.1）g/L,ALB was （21.8 ±8.1）g/L,while 24hUpro of group B was （5.4 ±2.3）g/L,ALB was （20.3 ±7.5）g/L,and 3 months of treatment,24hUpro was significantly decreased significantly and ALB increased in the two groups,24hUpro of group A was （3.2 ±1.2）g/L,ALB was （27.9 ±7.6）g/L,24hUpro of group B was （3.5 ± 1.3）g/L,ALB was （26.4 ±8.1）g/L.24hUpro showed a gradual downward trend（F=5.216,P〈0.05）,ALB showed a gradual upward trend（F=5.864,P〈0.05）.At different time points,the overall response rate between the two groups was no significant difference（P〉0.05）.The recurrence rate was 9.5% in group A,group B recurrence rate was 14.3%,which has no significant difference（P〉0.05）.The occurrence rate of adverse reactions of group A was 23.8 %and 28.6%in group,the difference between the two groups was not statistically significant（P〉0.05）. Conclusion The treatment of progestin hormone combined CTX has similar efficacy with CsA,and in clinical treat-ment,develop individualized treatment programs can be chosen according to the specific circumstances of the patients.