霉酚酸酯对Ⅳ型狼疮肾炎治疗的临床观察并文献复习

摘要

目的观察霉酚酸酯(MMF)对Ⅳ型狼疮肾炎(LN)的疗效。并对国内外MMF治疗LN的现况进行文献复习。方法对传统治疗方法无效的10例Ⅳ型LN患者给MMF 1～2 g/d加中小剂量激素进行治疗。治疗时间最长者1年，最短者6个月，并在治疗后3、6、12个月进行动态观察。结果治疗后尿蛋白逐渐减少，狼疮活动指数逐渐下降。治疗前后ANA阳性率分别为80%和30%，抗dsDNA抗体阳性率分别为50%和10%。低补体血症得以纠正，3例肾功能异常者经治疗后2例恢复正常，治疗中仅发现少数病人有消化道反应，个别病人有带状疱疹。结论 MMF对Ⅳ型LN治疗作用确切，副作用小。%Objective　To observe about curative effect of MMF on type Ⅳ lupus nephritis and to review the literature about MMF used to treat LN.Method　Ten patients with type Ⅳ LN were treated with MMF 1～2 g/d plus prednisone at middle or little dose.Curative duration of these patients was between 6 and 12 months.After 3,6 and 12 months curative effect was observed.Results　After treatment proteinurie and systemic lupus activity measurement were decreased gradually.Before and after treatment ANA positive rates were 80% and 30%,anti dsDNA antibody positive rates were 50% and 10%,respectively,and low C3 and C4 was rectified.After treatment renal failure in 3 patients was recovered.During treatment major adverse reactions included gastrointestinal symptoms and herpes zoster.Conclusion　MMF has exacttly effect on type Ⅳ LN and low side effect.