单次小剂量间断环磷酰胺冲击治疗难治性肾病综合征的临床观察

目的：探讨单次小剂量间断环磷酰胺冲击治疗（ cyclophosphamide pulse therapy,CPT）对成人难治性肾病综合征（RNS）的疗效,并观察环磷酰胺（CTX）的不良反应。方法成人RNS患者22例,开始每月予CTX 0．2g加入0．9%氯化钠溶液250mL,2h以上静脉滴注,隔日1次,连续3-4次,共3个月（ CTX 1．8-2．4g）；以后每隔2月重复上述治疗,共6个月,总疗程9个月（CTX总量3．6-4．8g）。同时联合泼尼松0．5mg/（kg·d）、抗凝及抗血小板等治疗,并在CPT治疗前后检查血常规、24h尿蛋白定量、肝、肾功能、全胸片及心电图,观察疗效及CTX不良反应。结果单次小剂量间断CPT 3个月后,22例患者中完全缓解（CR）5例（22．7%）,部分缓解（PR）16例（72．7%）,无效1例（4．5%）。9个月后, CR 19例（86．4%）、PR 2例（9．1%）、无效1例（4．5%）,且缓解患者（PR ＋CR）较治疗前血白蛋白（ALB）上升（P〈0．01）,24h尿蛋白定量下降（P〈0．01）,血总胆固醇（CHO）也较治疗前下降（P〈0．05）,4例血肌酐（Scr）增高者恢复正常。治疗过程中未出现明显的CTX不良反应。结论单次小剂量间断CPT能提高成人RNS临床缓解率,且无明显的不良反应,值得推广。

Effect of a Single Low-dose of Cyclophosphamide Pulse Therapy by Intermittent Infusion on Refractory Nephrotic Syndrome

Objective To explore the effect of a single low-dose of cyclophosphamide pulse therapy （ CPT） by intermit-tent infusion on adult refractory nephrotic syndrome （ RNS） and identify any features of cyclophosphamide （ CTX） toxicity. Meth-ods The study group consisted of 22 adult RNS hospitalized patients. They were treated 3 ~4 times per month at a single low-dose of CPT （0. 2g /qod） by intravenous infusion for 3 months （CTX 1. 8 -2. 4g）, then repeated it every 2 months for 6 months, total 9 months （CTX 3. 6-4. 8g）. At the same time these patients were treated with prednisone 8 -12weeks 0. 5mg/（ kg ·d） , anticoagulant and antiplatelet therapy. Any adverse reactions of CTX were observed in these patients by examination. Results Complete remission （CR） was observed in 5 （22. 7%） and partial remission （PR） in 16 （72. 7%） patients after 3 months,one patient was invalid （4. 5% ）. After 9 months of treatment CR was observed in 19 （86. 4%） and PR in 2 （9. 1%） patients, one patient was invalid （4. 5%）, in remission patients （CR＋PR） the level of serum albumin increased markedly （P〈0. 01）, proteinuria and cholesterol （CHO） were reduced significantly （P〈0. 01; P〈0. 05,respectively）. The reduced renal function in 4 patients before treatment returned to normal. side-effects were minimal. Conclusion A single low-dose of CPT by intermittent infusion enhanced significant remission rate of adult RNS with minimal side-effects.