吗替麦考酚酯与环磷酰胺联合激素治疗成人难治性肾病综合征的疗效和安全性比较

摘要

Objective It is to conpare the efficacy and safety of combined therapy of mycophenolate mofetil or cyclophosphamide with prednisone in the treatment of adult patients with refractory nephrotic syndrome (RNS).Methods 114 cases of adult patients with refractory nephrotic syndrome were selected and randomly divided into two groups,57 cases in each.All patients of the two groups were given prednisone treatment,and the patients was added mycophenolate mofetil in the observation group added cyclophosphamide in the control group.The efficacy evaluation was performed after 6 months of treatment in the two groups to compare the renal function changes of the two groups before and after the treatment.At the same time the adverse drug reactions in the two groups were recorded during the treatment.Results After 24h of the treatment in the two groups,urinary protein significantly reduced,and the level of ALB significantly increased (all P ＜ 0.05).But the improvement degree of the two indexes in the observation group was more obvious (P ＜ 0.05);after the treatment,the levels of SCr and BUN in the observation group were significantly decreased (all P ＜ 0.05),while there was no obvious change in the control group (P ＞ 0.05);the total effective rate was 96.49％ in the observation group,and was 73.68％ in the control group,there was significant difference between the both groups (P ＜ 0.05);the incidence rate of adverse reactions was 3.51％ in the observation group,and was 29.82％ in the control group,there was significant difference between the bothe groups (P ＜ 0.05).Conclusion The combined therapy of mycophenolate mofetil and hormone for adult patients with refractory nephrotic syndrome is more accurate than cyclophosphamide combined with hormone.It can effectively improve the renal function of the patients,and the adverse reaction rate is low with high safety of drug,which has high clinical application value.%目的 比较吗替麦考酚酯与环磷酰胺联合激素治疗成人难治性肾病综合征的疗效和安全性.方法 选取114例成人难治性肾病综合征患者随机分成观察组与对照组各57例.2组均给予泼尼松治疗,观察组加用吗替麦考酚酯,对照组加用环磷酰胺,治疗6个月后进行疗效评估,比较2组治疗前后肾功能变化情况,同时记录2组治疗过程中药物不良反应发生情况.结果 治疗后2组24 h尿蛋白定量均明显减少,ALB水平明显上升(P均＜0.05),且观察组改善程度较对照组更为明显(P均＜0.05);治疗后观察组BUN、SCr水平均明显下降(P均＜0.05),但对照组则无明显改变(P均＞0.05);观察组总有效率明显高于对照组(P＜0.05),不良反应发生率明显低于对照组(P＜0.05).结论 吗替麦考酚酯联合激素治疗成人难治性肾病综合征相对于环磷酰胺联合激素治疗疗效更为确切,能有效提高患者的肾功能,且不良反应发生率低,药物使用安全性高,具有较高的临床应用价值.