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[目的]比较霉酚酸酯(MMF)与间断环磷酰胺(CTX)静脉冲击疗法治疗弥漫增生性(Ⅳ型)狼疮性肾炎(LN)的临床疗效。[方法]对2002～2008年来在海南省人民医院肾病内科住院经肾穿刺活检确诊为Ⅳ型狼疮性肾炎患者35例,比较同期激素联合MMF(MMF组,n=16例)与激素联合CTX间断静脉冲击治疗(CTX组,n=19例)的疗效。MMF剂量1.0g/d或1.5g/d;CTX剂量为0.75～1.0g/kg·m2,每月静脉滴注1次。两组临床及肾活检病理表现相似。比较两组治疗12个月的完全缓解率及部分缓解率。[结果](1)临床缓解率:治疗12个月时MMF组和CTX组,完全缓解率分别为43.7%和26.3%,部分缓解率分别为25.0%和47.3%;(2)尿蛋白变化:MMF组尿蛋白完全缓解率(≤0.4g/24h)高于CTX组(43.7%VS26.3%);(3)自身抗体变化:MMF组与CTX组患者分别有81.3%及74.2%血清抗ds-DNA转阴;(4)不良反应:MMF组发生带状疱疹、呼吸道感染、腹泻、白细胞下降各1例;CTX组发生呼吸道感染、尿路感染、白细胞下降、胃肠道反应各2例,肝酶升高1例。[结论]与CTX方案比较,MMF治疗Ⅳ型狼疮性肾炎取得更高的完全缓解率,且不良反应较CTX少见,安全性好。
[Objective] To compare the clinical efficacy of mycophenolate mofetil (MMF) and intermittent cyclophosphamide (CTX) in the treatment of diffuse hyperplastic lupus nephritis (LN). [Methods] From 2002 to 2008, 35 patients with type Ⅳ lupus nephritis diagnosed by renal biopsy in hospital of Department of Nephrology, Hainan Provincial People ’s Hospital were enrolled in this study. 35 cases of steroid - associated lupus nephritis (MMF) Intravenous impact therapy (CTX group, n = 19). MMF dose of 1.0g / d or 1.5g / d; CTX dose of 0.75 ~ 1.0g / kg · m2, a monthly intravenous infusion. Two groups of clinical and renal biopsy showed similar pathology. The complete remission rate and partial remission rate were compared between the two groups for 12 months. [Results] (1) Clinical remission rate: The complete remission rate was 43.7% and 26.3% in MMF group and CTX group at 12 months after treatment, respectively. The partial remission rates were 25.0% and 47.3% respectively. (2) The complete remission rate of urinary protein in MMF group (≤0.4g / 24h) was higher than that in CTX group (43.7% VS26.3%). (3) The changes of autoantibodies in MMF group were 81.3% and 74.2% (4) Adverse reactions: 1 case of herpes zoster, respiratory tract infection, diarrhea and leukopenia occurred in MMF group. There were 2 cases of respiratory tract infection, urinary tract infection, leukopenia and gastrointestinal tract reaction in CTX group, Liver enzyme increased in 1 case. [Conclusion] Compared with the CTX regimen, MMF treatment of type Ⅳ lupus nephritis achieved higher complete remission rate, and adverse reactions than CTX rare, good safety.