摘要
目的前瞻性研究霉酚酸酯(MMF)治疗乙型肝炎病毒相关性肾炎的临床疗效和安全性。方法选择血清HBV标记物阳性、病理诊断为乙型肝炎病毒相关性肾炎的患者共18例,随机分为两组,每组9例,第一组采用MMF联合皮质激素治疗方案,MMF初始剂量1.0～1.5g/d,同时口服强的松0.5～0.8mg·kg-·1d-1。第二组采用皮质激素治疗,强的松0.5～0.8mg·kg-·1d-1。两组中有HBV蛳DNA复制的均给予干扰素蛳α或拉米夫定治疗。结果①治疗3个月时,MMF组尿蛋白定量如(2.7±2.5)g/d较治疗前的(4.9±2.9)g/d明显减少(P<0.05),血浆白蛋白为(34.7±7.3)g/L较治疗前的(26.0±6.2)g/L明显升高(P<0.05);对照组尿蛋白定量和血浆白蛋白与治疗前相比无显著改善(P>0.05)。治疗6个月时,MMF组尿蛋白定量为(1.4±0.7)g/24h较治疗前的(4.9±2.9)g/24h明显减少(P<0.01),血浆白蛋白为(35.1±5.6)g/L较治疗前的(26.0±6.2)g/L明显升高(P<0.01)。对照组尿蛋白定量为(2.7±1.6)g/24h较治疗前的(5.6±2.2)g/24h明显减少(P<0.05),血浆白蛋白为(33.8±9.5)g/L较治疗前的(26.2±6.0)g/L显著升高(P<0.05)。治疗6个月时MMF组尿蛋白定量为(1.4±0.7)g/24h显著低于对照组的(2.7±1.6)g/24h(P<0.05)。MMF组6个月时的完全缓解率(44.4%)与对照组(11.1%)比较无显著性差?
Objective To investigate the efficacy, safety and tolerance of mycophenolate mofeil (MMF) in HBV-associated glomerulonephritis. Methods Eighteen patients with HBV-associated glomerulonephritis diagnosed by renal biopsy and urinary protein > 2.0g/d were enrolled randomly in the trail. Nine patients were treated by MMF combined with prednisone. The initial dosage of MMF was 1.0 ～ 1.5g/d. The dosage was reduce to 0.75 ～ 1.0/d after 6 months treatment. The dosage of Prednisone was 0.5 ～ 0.8mg·kg-1·d-1 at the beginning of the combined treatment and then reduced gradually. Another 9 patients matched with age, gender and severity of renal damage were given prednisone orally (0.5 ～ 0.8 mg·kg-1·d-1, control group). Blood and urinary tests, hepatic and renal function, plasma albumin, serum triglyceride and cholesterol, 24h protein excretion, urinary NAG enzyme, creatinine clearance (Ccr) were performed before and 3, 6 months treatment in both groups. Results ① After 3 months treatment, decrease of urinary protein 〔(2.7 ± 2.5)g/24h vs. (4.9 ± 2.9) g/24h, P < 0.05〕 and improvement of plasma albumin 〔(34.7 ± 7.3)g/L vs. (26.0 ± 6.2) g/L, P < 0.05〕 were observed in MMF group. While in control group, no significant change were found in urinary protein and plasma albumin. After 6 months treatment, both groups showed obvious alleviation of proteinuria and improvement of albumin. But the proteinuria in MMF group was significantly improved than that of control group 〔(1.4 ± 0.7)g/24h vs. (2.7 ± 1.6) g/24h,P < 0.05〕. The total effective rate of MMF group was higher compared to that of the control group (88.9% vs. 22.2%, P < 0.05). ② Serum cholesterol and triglyceride were remarkably reduced after 6 months treatment in MMF group (P < 0.05), and no significant difference was found in control group. Conclusions The therapy of MMF combined with prednisone is more effective in reducing proteinuria and serum lipid than prednisone in HBV-associated glomerulonephritis with less adverse effect.
出处
《北京医学》
CAS
2005年第3期166-169,共4页
Beijing Medical Journal
基金
国家自然科学基金项目资助(编号30121005)
