烷化剂在1例特发性膜性肾病合并肾病综合征的循证应用

目的报告应用烷化剂对1例特发性膜性肾病(IMN)合并肾病综合征(NS) 患者进行的循证治疗过程。方法计算机检索Cochrane图书馆(2005年第3期)、MEDLINE(1978-2005)、 CBM disc(1978～2005),查找烷化剂治疗IMN合并NS及与病情缓解有关的系统评价、临床随机对照试验等,获取最佳证据用于临床治疗。结果高质量的临床证据表明,烷化剂能明显提高IMN合并NS患者蛋白尿的完全缓解率,其中糖皮质激素 环磷酰胺(MP CTX)的方案是较安全和有效的,但其能否提高肾脏的长期存活率尚不确定。据此,笔者结合临床经验及患者意愿,对患者实施MP CTX免疫抑制治疗,6个月后患者蛋白尿情况有所缓解,目前仍在随访中。结论 MP CTX方案能明显提高IMN合并NS患者的蛋白尿缓解率,但能否提高患者肾脏长期存活率,尚有待进一步观察。

Evidence-based Treatment of Alkylating Agents for Idiopathic Membranous Nephropathy with Nephrotic Syndrome

Objective We intended to get a good understanding of the current role of alkylating agents in the treatment of idiopathic membranous nephropathy (IMN) with nephrotic syndrome (NS). Methods We searched the Cochrane Library (Issue 3, 2005), MEDLINE (1978 Jun., 2005) and CBM disc( 1978-2005) to get the current best evidence of alkylating agents for treating IMN with NS and further critically appraised the available evidence. Results Alkylating agents showed a significant beneficial effect on complete remission of proteinuria. The treatment of glucocorticoid with cyclophosphamide (MP CTX) was one of the best managements among the various regimens suggested for IMN, but it was not clear about its long-term effect on renal survival rate. Given the current best evidence together with our clinical experience and the attitudes of the patient and family members, the treatment of (MP CTX) was administered. There was a significant remission of proteinuria after 6 months follow-up. Conclusions The treatment of (MP CTX) can significantly improve the remission of proteinuria, however further observations on the long-term effect of alkylating agents on renal survival rate are required.