霉酚酸酯治疗乙型肝炎病毒相关性肾炎的临床观察

目的观察应用霉酚酸酯(MMF)治疗乙型肝炎病毒相关性肾炎的临床疗效及安全性。方法对2000年1月至2005年1月中国医科大学附属盛京医院20例乙型肝炎病毒相关性肾炎患者给予MMF治疗,起始剂量为1.5g/d,尿蛋白降至0.5g/d时剂量减至1.0g/d维持,有乙型肝炎病毒(HBV)DNA复制的给予拉米夫定治疗。治疗前及治疗后2,3,6,9个月检测血常规、24h尿蛋白定量、血清白蛋白、肝功能、肾功能、血脂及HBVDNA定量,并记录不良反应情况。结果治疗后24h尿蛋白量明显减少(P<0.01),血清白蛋白明显上升(P<0.05),Scr明显下降(P<0.05),胆固醇及三酰甘油水平明显降低(P<0.05),未发现病毒复制增加。随访9个月完全缓解9例,总有效率85%。治疗期间未发现严重不良反应。结论MMF用于治疗乙型肝炎病毒相关性肾炎有明显疗效,且耐受性好,未见严重不良反应。

Clinical study of mycophenolate mofetil treatment in HBV associated glomerulonephritis

Objective To investigate the efficacy and the adverse effect of mycophenolate mofetil(MMF)in HBV associated glomerulonephritis.Methods Twenty patients with HBV-GN diagnosed by renal biopsy were treated with MMF.The initial dosage of MMF was 1.5 g/d.The dosage was reduced to 1.0 g/d when 24 h excretion of urinary protein decreased to 0.5 g/d.Blood routine test,hepatic and renal function,plasma albumin,serum triglyceride and cholesterol,24 h urinary protein excretion,HBV DNA were performed before and after 2,3,6,9 months' treatment.Results Twenty-four-hour urinary protein excretion was significantly reduced by the treatment with mycophenolate mofetil(P<0.01).The serum albumin was significantly improved(P<0.05).Serum creatinine,triglyceride and cholesterol were remarkably reduced(P<0.05).The reproduction of HBV didn't increase.Nine cases had fully remission and the total effective rate was 85% after 9 months' treatment.There were no serious adverse effects during the period of administrating the drugs.Conclusion The therapy of MMF is effective in HBV-associated glomerulonephritis with less adverse effect.