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目的:回顾性对照研究霉酚酸酯(MMF)与环磷酰胺(CTX)治疗新月体性狼疮性肾炎(CLN)的疗效、复发率、远期预后和副作用的差异。方法:对1998年1月至2005年6月在解放军肾脏病研究所住院肾活检确诊(新月体形成率≥50%)CLN且经MMF或CTX诱导治疗的患者进行一般状况、临床表现、病理特征、治疗缓解率、复发率、副作用发生率及预后的回顾性对比分析。结果:52例CLN患者中,接受CTX治疗25例(2例失访),MMF治疗27例(1例失访)。CTX组和MMF组患者一般状况、临床表现及狼疮活动性指数(SLEDAI)、病理损害程度间无显著性差异,两组治疗12个月时缓解率分别为69.6%和73.1%,MMF组完全缓解率(53.8%)显著高于CTX组(26.1%),复发率(10.5%)则显著低于CTX组(43.8%),CTX组复发者多来自部分缓解者(占部分缓解患者的40.0%)。CTX组有部分患者出现药物副作用,包括肺部感染(3例,占13.0%)、肝损害(2例,占8.70%)和白细胞下降(1例,占4.35%);MMF组带状疱疹1例(占3.85%)、白细胞下降1例(占3.85%)。CTX组和MMF组随访时间分别为:10～80(38.5±21.2)月和12～90(41.1±27.0)月,无显著性差异。CTX组有2例(8.70%)患者分别在随访第48个月和第60个月进入终末期肾衰(ESRF),3例(13.0%)死亡,其中2例死于重症肺部感染,1例患者死于尿毒症后脑出血;MMF组有2例(7.41%)患者分别在随访第8个月和第24个月进入ESRF,无死亡病例。结论:与传统CTX方案比较,MMF治疗CLN取得更高的完全缓解率和低复发率,且感染副作用较CTX少见,安全性好。
OBJECTIVE: To retrospectively study the efficacy, recurrence rate, long-term prognosis and side effects of mycophenolate mofetil (MMF) and cyclophosphamide (CTX) in the treatment of crescentic lupus nephritis (CLN). Methods: From January 1998 to June 2005, patients with clinically diagnosed CLN (≥50% crescent formation rate) CLN induced by MMF or CTX were enrolled in the PLA Renal Disease Institute. The general conditions, clinical manifestations, Retrospective comparative analysis of characteristics, treatment response rate, recurrence rate, incidence of side effects and prognosis. Results: Of the 52 patients with CLN, 25 received CTX (2 lost) and MMF treated 27 (1 lost). There was no significant difference between CTX group and MMF group in general status, clinical manifestations, SLEDAI and pathological damage. The remission rates of the two groups were 69.6% and 73.1% respectively at 12 months, and were completely relieved in MMF group (53.8%) was significantly higher than that of CTX group (26.1%), and the recurrence rate (10.5%) was significantly lower than that of CTX group (43.8%). Most of CTX group relapsed patients were from partial remission (40.0% . Side effects were observed in some patients in the CTX group, including pulmonary infection (3 cases, 13.0%), liver damage (2 cases, 8.70%) and leukopenia (1 case, 4.35%); Cases (3.85%), leukopenia in 1 case (3.85%). The follow-up time of CTX group and MMF group was 10 ~ 80 (38.5 ± 21.2) months and 12 ~ 90 (41.1 ± 27.0) months respectively, with no significant difference. Two patients (8.70%) in the CTX group entered end-stage renal failure (ESRF) at the 48th and 60th months of follow-up, and 3 (13.0%) died, 2 of whom died of severe pulmonary infection, 1 Patients died of uremic hemorrhage. Two patients (7.41%) in the MMF group entered the ESRF at the 8th and 24th months of follow-up, respectively, without any deaths. Conclusion: Compared with the traditional CTX regimen, MMF treatment of CLN achieved higher complete remission rate and low recurrence rate, and the side effects of infection than CTX rare, good safety.