目的：评价小剂量醋酸泼尼松、环孢素A、雷公藤多苷三联疗法对特发性膜性肾病的疗效及安全性。方法随机将2010-2013年在我院确诊的58例特发性膜性肾病患者分为2组,对照组给予醋酸泼尼松[0．5 mg/(kg·d)]与环孢素A[3~5 mg/(kg·d)]联合治疗,治疗组给予醋酸泼尼松[0．5 mg/(kg·d)]、环孢素A [2~3 mg/(kg·d)]、雷公藤多苷(60 mg/d)三联治疗,观察12个月,分别于治疗后1、3、6、12个月检测患者血肌酐、血清白蛋白、24 h尿蛋白定量,比较两种治疗方案的临床疗效以及不良反应。结果治疗前两组患者血肌酐、血清白蛋白、24 h尿蛋白定量比较差异无统计学意义( P>0．05)。12个月后治疗组与对照组的缓解率分别为82．7%、79．3%,治疗组略高于对照组,但差异无统计学意义(P>0．05),对照组有3例患者出现肌酐升高,1例发生肺部感染,1例发生皮肤疱疹病毒感染。结论小剂量激素联合环孢素A、雷公藤多苷三联疗法治疗特发性膜性肾病的缓解率与激素联合常规剂量环孢素A的缓解率相当,但费用较低,不良反应发生率低,值得临床推广。%Objective To investigate the efficacy and safety of low dosage of glucocorticoid(Pred),cyclos-porin A(CsA)and tripterygiumwilfordiihook(TWH)combined therapy in the treatment of idiopathic membranous ne-phropathy( IMN) . Methods 58 cases of IMN in our hospital from 2010 to 2013 were randomly divided into two groups,control group was given Pred [0. 5 mg/(kg·d)] and CsA [3 ~5 mg/(kg·d)],treatment group was given Pred [0. 5 mg/(kg·d)],CsA [2~3 mg/(kg·d)] and TWH(60 mg/d). After 1,3,6,12 months of treatment,the se-rum albumin( ALB), serum creatinine( Cr), and 24 hours urine protein were observed. Results Before treatment,there was no significant difference in Scr,ALB and 24 hours urinary protein between the two groups(P>0. 05). The remis-sion rates( RR) of treatment group and control group were 82. 7% and 79. 3%,there was no significant difference be-tween the two groups(P>0. 05). In control group,Scr level of 3 patients elevated,1 patient encountered pulmonary in-fection,and 1 patient met withdermatic infection of herpes simplex virus. Conclusion The remission rate of combined therapy with low dosage of Pred,CsA and TWH is nearly to the combined therapy with Pred and normal dosage of CsA with lower cost and incidence of side effects.
展开▼
