强的松联合霉酚酸酯与联合环磷酰胺治疗重症IgA肾病疗效比较

 目的比较强的松联合霉酚酸酯(mycophenolatemofetil，MMF)与强的松联合环磷酰胺(cyclophosphamide，CYC)治疗重症IgA肾病的临床疗效。方法84例重症IgA肾病患者分别给予强的松联合MMF治疗(MMF组，n=42)，强的松联合CYC治疗(CYC组n=42)。强的松起始剂量40mg/d，MMF诱导期剂量1.5g/d，持续6个月;维持期剂量0.75~1.0g/d，持续12个月。CYC诱导期剂量为0.8~1.0g/月，静脉滴注，持续6个月;维持期剂量0.8~1.0g/3月，持续12个月。两组患者基础病情无差异，随访时间18个月，观察两组患者临床缓解率及相应实验室指标，如24h尿蛋白定量、血肌酐、血浆白蛋白、总蛋白、血脂变化，并比较两组治疗的不良反应。结果(1)临床缓解率:治疗18个月时MMF组临床总有效率高于CYC组，分别为85.7%vs61.8%(P＜0.05);(2)观察期末，MMF组患者24h尿蛋白定量(0.6±0.3)明显低于CYC组(1.4±0.5)(P＜0.05)，血浆白蛋白和总蛋白(43.2±4.3和70.2±8.1)均显著高于CYC组患者(36.9±3.6和60.3±7.6)(P＜0.05);(3)血脂变化:MMF组血脂较治疗前明显降低，而CYC组无变化(P＜0.05);(4)不良反应发生率:MMF组不良反应发生率(4.76%)明显低于CYC组(19.0%)。结论MMF组治疗重症IgA肾病，临床缓解率高于CYC组疗法，能更有效降低患者24h尿蛋白定量，改善患者血脂和血浆白蛋白水平，维持患者肾功能稳定，并且MMF组不良反应发生率显著低于CYC组疗法。

Comparison of clinical efficacy between prednisone combined with mycophenolate mofetil or cyclophosphamide in treatment of patients with severe IgA nephropathy

Objective To compare the clinical efficacy between prednisone combined with mycophenolate mofetil or cyclophosphamide treatment in patients with severe IgA nephropathy. Methods A total of 84 patients with severe IgA nephropathy were treated with the prednisone combined with mycophenolate mofetil (MMF group, n=42) or cyclophosphamide (CTX group, n=42), separately. The initial dosage of prednisone was 40 mg/d, and the dose of MMF was 1.5 g/d in induction stage for 6 months, and 0.75~1.0 g/d in maintenance stage for 12 months. The dose of CTX was 0.8-1.0 g/month in induction stage, by intravenous infusion, for 6 months, and 0.8 -1.0 g/3 months in maintenance stage for 12 months. There was no difference in the basal state between the two groups. All patients were administered for 18 months. The clinical remission rate and the corresponding laboratory parameters were observed, including 24-hour urinary protein excretion, serum creatinine, serum albumin, total protein, and lipid changes. The side effects of treatment were also compared between the two groups. Results (1)The clinical remission rate in MMF group of 18 months (85.7%) was higher than that in CTX group (61.8%) (P<0.05). (2) By the end of observation period, 24-hour urinary protein excretion in patients of MMF group (0.6 ± 0.3) was significantly lower than that in patients of CTX group (1.4±0.5) (P<0.05), plasma albumin and total protein in patients of MMF group (43.2±4.3 and 70.2±8.1) was significantly higher than that in patients of CTX group (36.9±3.6 and 60.3±7.6) (P＜0.05). (3)Blood lipids in patients of MMF group were significantly reduced than before(P<0.05), while those in patients of the CTX group did not change (P>0.05). (4)The incidence of side effects: in patients of the MMF group (4.76%) was significantly lower than that in patients of the CTX group (P<0.05). Conclusions The clinical remission rate of prednisone with MMF is higher than that of prednisone with CTX in patients with severe IgA nephropathy. And the prednisone with MMF therapy reduces 24 h urine protein effectively, improves blood lipids and plasma albumin levels to maintain stable renal function. Moreover, the side effects in the group of MMF therapy are significantly lower than those in the group of CTX therapy.