[1]陈晓霞,唐 勇,胡 庆,等.吗替麦考酚酯联合糖皮质激素治疗特发性膜性肾病的疗效观察[J].医学信息,2018,31(22):89-92.[doi:10.3969/j.issn.1006-1959.2018.22.024]
　CHEN Xiao-xia,TANG Yong,HU Qing,et al.Therapeutic Effect of Mycophenolate Mofetil Combined with Glucocorticoid on Idiopathic Membranous Nephropathy[J].Journal of Medical Information,2018,31(22):89-92.[doi:10.3969/j.issn.1006-1959.2018.22.024]
点击复制

吗替麦考酚酯联合糖皮质激素治疗特发性膜性肾病的疗效观察()
分享到：

医学信息[ISSN:1006-1959/CN:61-1278/R]

卷:
31卷
期数:
2018年22期
页码:
89-92
栏目:
论著
出版日期:
2018-11-15

文章信息/Info

Title:
Therapeutic Effect of Mycophenolate Mofetil Combined with Glucocorticoid on Idiopathic Membranous Nephropathy
文章编号:
1006-1959（2018）22-0089-04C
作者:
陈晓霞; 唐 勇; 胡 庆; 王茂合
（遂宁市中心医院肾内科，四川 遂宁 629000）
Author(s):
CHEN Xiao-xia; TANG Yong; HU Qing; WANG Mao-he
(Department of Nephrology,Suining Central Hospital,Suining 629000,Sichuan,China)
关键词:
特发性膜性肾病; 吗替麦考酚酯; 糖皮质激素; 环磷酰胺
Keywords:
Idiopathic membranous nephropathy; Mycophenolate mofetil; Glucocorticoid;  Cyclophosphamide
分类号:
R692.3
DOI:
10.3969/j.issn.1006-1959.2018.22.024
文献标志码:
A
摘要:
目的 比较吗替麦考酚酯和环磷酰胺治疗特发性膜性肾病的有效性及安全性。方法 选择2011年8月~2013年8月在遂宁市中心医院确诊为特发性膜性肾病的患者40例，随机分为吗替麦考酚酯治疗组和环磷酰胺治疗组，各20例，分别给予吗替麦考酚酯和环磷酰胺联合糖皮质激素治疗。在治疗后6、12、24和36个月，检测两组患者尿蛋白定量、血清白蛋白、血肌酐、内生肌酐清除率、胆固醇及甘油三酯，同时观察并记录两组患者不良反应情况。结果 治疗12个月后，两组患者尿蛋白定量、血清白蛋白、血肌酐及胆固醇水平较治疗前均改善，但两组间比较差异无统计学意义（P＞0.05）。治疗24月后，MMF组患者尿蛋白定量、血清白蛋白、胆固醇及甘油三酯分别为（1.19±5.15）g/24h、（40.14±3.96）g/L、（4.73±0.64）mmol/L和（1.88±0.28）mmol/L，而CTX组患者相应指标为（1.82±0.94）g/24h、（36.05±3.52）g/L、（5.33±0.76）mmol/L和（2.13±0.29）mmol/L，两组患者数据比较，差异具有统计学意义（P＜0.05）。两组患者蛋白尿总缓解率在36个月后分别为90.00%和80.00%，差异无统计学意义（P＞0.05）。两组患者在药物不良反应比较，差异无统计学意义（P＞0.05）。结论 吗替麦考酚酯联合糖皮质激素治疗特发性膜性肾病疗效肯定，和环磷酰胺相比，其降尿蛋白效果更佳，同时药物不良反应更少。
Abstract:
Objective To compare the efficacy and safety of mycophenolate mofetil and cyclophosphamide in the treatment of idiopathic membranous nephropathy.Methods A total of 40 patients with idiopathic membranous nephropathy diagnosed in Suining Central Hospital from August 2011 to August 2013 were randomly divided into the mycophenolate mofetil treatment group and the cyclophosphamide treatment group, 20 cases each. Treatment with mycophenolate mofetil and cyclophosphamide in combination with glucocorticoids. At 6, 12, 24, and 36 months after treatment, urine protein quantitation, serum albumin, serum creatinine, endogenous creatinine clearance, cholesterol, and triglycerides were measured in both groups, and adverse events were observed and recorded in both groups.Results After 12 months of treatment, urine protein quantitation, serum albumin, serum creatinine and cholesterol levels were improved in both groups, but there was no significant difference between the two groups(P>0.05). After 24 months of treatment, urine protein quantitation, serum albumin, cholesterol and triglycerides in the MMF group were (1.19±5.15) g/24h, (40.14±3.96) g/L, (4.73±0.64) mmol/L, and (1.88±0.28) mmol/L, and the corresponding indicators of patients in the CTX group were (1.82±0.94) g/24h, (36.05±3.52) g/L,(5.33±0.76) mmol/L and (2.13±0.29) mmol/L, comparison of data between the two groups, the difference was statistically significant(P<0.05). The total proteinuria remission rate in the two groups was 90.00% and 80.00% after 36 months, the difference was not statistically significant(P>0.05). There were no significant differences in adverse drug reactions between the two groups(P>0.05). Conclusion The efficacy of mycophenolate mofetil combined with glucocorticoid in the treatment of idiopathic membranous nephropathy is more effective than cyclophosphamide, and it has better urinary protein lowering effect and less adverse drug reactions.

参考文献/References:


[1]Ronco P,Debiec H.Pathophysiological advances in membranous nephropathy:time for a shift in patient's care[J].Lancet,2015,385(9981):1983-1992.
[2]Timmermans SA,Hamid MAA,Tervaert JWC,et al.Anti-PLA2R Antibodies as a Prognostic Factor in PLA2R-Related Membranous Nephropathy[J].American Journal of Nephrology,2015,42(1):70-77.
[3]Dussol B,Morange S,Burtey S,et al.Mycophenolate Mofetil Monotherapy in Membranous Nephropathy: A 1-Year Randomized Controlled Trial[J].American Journal of Kidney Diseases,2008,52(4):699-705.
[4]傅鹏,原爱红,于建平,等.吗替麦考酚酯联合激素治疗特发性膜性肾病36个月的前瞻对照性研究[J].第二军医大学学报,2012,33(3):270-273.
[5]Brenchley PE.Anti-phospholipase A2 receptor antibody and immunosuppression in membranous nephropathy:More evidence for pathogenicity of anti-phospholipase A2 receptor autoantibodies[J].J Am Soc Nephrol,2015,26(10):2308-2311.
[6]Tomas NM,Beck LH Jr,Meyer-Schwesinger C,et al.Thrombospondin type-1 domain-containing 7A in idiopathic membranous nephropathy[J].N Engl J Med,2014,371(24):2277-2287.
[7]Ren S,Wu C,Zhang Y,et al.An update on clinical significance of use of THSD7A in diagnosing idiopathic membranous nephropathy:a systematic review and meta-analysis of THSD7A in IMN[J].Ren Fail,2018,40(1):306-313.
[8]任松,李贵森.特发性膜性肾病的发病机制研究[J].实用医院临床杂志,2017,14(2):109-112.
[9]Ren S,Wang Y,Xian L,et al.Comparative effectiveness and tolerance of immunosuppressive treatments for idiopathic membranous nephropathy:A network meta-analysis[J].PLoS One,2017,12(9):e0184398.
[10]Shin DH,Lee MJ,Oh HJ,et al.Stepwise treatment using corticosteroids alone and in combination with cyclosporine in korean patients with idiopathic membranous nephropathy[J].Yonsei Med J,2013,54(4):973-982.
[11]Ogarek I,Szczesny-Choruz E,Wierzchowska-Slowiaczek E,et al.Mycophenolate mofetil (MMF) as the first choice immunosuppressive drug in treatment of steroid-dependent nephrotic syndrome in children[J].Pol Merkur Lekarski,2018,44(262):192-195.
[12]Yu CC,Yang CW,Wu MS,et al.Mycophenolate mofetil reduces renal cortical inducible nitric oxide synthase mRNA expression and diminishes glomerulosclerosis in MRL/lpr mice[J].J Lab Clin Med,2001,138(1):69-77.
[13]Fu P,Yuan AH,Yu JP,et al.Mycophenolate mofetil combined with prednisone for treatment of idiopathic membranous nephropathy with nephrotic syndrome:A 36-month prospective controlled study[J].Academic Journal of Second Military Medical University,2012,33(3):270-273.
[14]Chen Y,Schieppati A,Cai G,et al.Immunosuppression for membranous nephropathy: a systematic review and meta-analysis of 36 clinical trials[J].Clin J Am Soc Nephrol,2013,8(5):787-796.
[15]胡雨云.吗替麦考酚酯对特发性膜性肾病临床疗效及安全性的系统评价[D].广西医科大学,2015.

相似文献/References:

[1]袁 刚.特发性膜性肾病患者肾组织及血液中PLA2R抗体表达的检测及其意义[J].医学信息,2020,33(12):99.[doi:10.3969/j.issn.1006-1959.2020.12.029]
　YUAN Gang.Detection and Significance of PLA2R Antibody Expression in Renal Tissue and Blood of Patients with Idiopathic Membranous Nephropathy[J].Journal of Medical Information,2020,33(22):99.[doi:10.3969/j.issn.1006-1959.2020.12.029]
[2]鲍江波.雷公藤多苷和泼尼松片联合治疗特发性膜性肾病的有效性分析[J].医学信息,2020,33(14):157.[doi:10.3969/j.issn.1006-1959.2020.14.050]
　BAO Jiang-bo.Analysis of the Efficacy of Tripterygium Glycosides and Prednisone Tablets in the Treatment of Idiopathic Membranous Nephropathy[J].Journal of Medical Information,2020,33(22):157.[doi:10.3969/j.issn.1006-1959.2020.14.050]
[3]左俊荣.特发性膜性肾病的诊断及治疗研究[J].医学信息,2021,34(11):54.[doi:10.3969/j.issn.1006-1959.2021.11.016]
　ZUO Jun-rong.Research on the Diagnosis and Treatment of Idiopathic Membranous Nephropathy[J].Journal of Medical Information,2021,34(22):54.[doi:10.3969/j.issn.1006-1959.2021.11.016]

更新日期/Last Update: 2018-12-03