目的 回顧性觀察糖皮質(zhì)激素聯(lián)合小劑量嗎替麥考酚酯（MMF）對IgA腎病的臨床療效及安全性。 方法 2010年9月－2012年9月在我科門診就診的28例IgA腎病患者接受了小劑量MMF聯(lián)合激素治療。醋酸潑尼松起始劑量為0.6 mg/（kg·d），MMF起始劑量為0.5～1.0 g/d，2～4周內(nèi)調(diào)節(jié)藥物劑量使血藥濃度（MPA-AUC）維持在30～60 mg·h/L。治療前及治療后每月隨訪觀察血清肌酐、血清白蛋白、尿蛋白定性、24 h尿蛋白定量及藥物不良反應(yīng)等指標(biāo)。誘導(dǎo)期初定為6個月，若6個月未完全緩解（CR）則延長至9個月，總療程至少12個月，主要評價指標(biāo)為誘導(dǎo)治療期的完全緩解率。 結(jié)果 全部患者均完成了12個月的隨訪觀察，全組28例中CR 8例（28.6%），部分緩解（PR）14例（50.0%），未緩解（NR）6例（21.4%），總有效率78.6%。隨訪過程中，3例患者出現(xiàn)呼吸道感染，其中2例住院治療；2例患者出現(xiàn)尿路感染，1例患者出現(xiàn)腹瀉。 結(jié)論 小劑量MMF治療IgA腎病安全、有效且能在一定程度上節(jié)省患者費用，可作為其他免疫抑制方案治療無效或復(fù)發(fā)時的一種治療選擇。
【摘要】 目的 觀察激素加霉酚酸酯（mycophenolate mofetil，MMF）和他克莫司（tacrolimus，F(xiàn)K506）的多靶點方案治療難治性腎小球疾病的療效及安全性?！》椒ā?008年5月-2010年3月收治的15例狼瘡性腎炎（lupus nephritis，LN）、3例膜增生性腎小球腎炎（membranoproliferative glomerulonephritis，MPGN）及3例膜性腎?。╩embranous nephropathy，MN）患者，因多種免疫抑制劑治療無效或復(fù)發(fā)而改用多靶點療法。潑尼松以30~40 mg/d起始，逐漸減量。MMF 和FK506起始劑量分別為0.5 g/d或1 mg/d，目標(biāo)血藥濃度分別為20~40 mg/（h·L）或5~8 ng/mL。定期隨訪觀察肝腎功能、尿蛋白定量、不良反應(yīng)等指標(biāo)。 結(jié)果 治療6個月時15例LN中7例（46.7%）完全緩解（complete remission，CR），5例（33.3%）部分緩解（partial remission，PR），3例（20%）無效（no response，NR）。3例MPGN均表現(xiàn)為NR。3例MN中2例（66.7%）PR，1例（33.3%）NR。治療過程中呼吸道感染及脫發(fā)各1例，胃腸不適2例，肌酐逐步升高3例，無死亡或退出者?！〗Y(jié)論 多靶點療法對難治性LN安全、有效，可作為其他免疫抑制劑治療無效或復(fù)發(fā)時的選擇方案，但對MPGN和MN療效欠佳，需進一步研究?！続bstract】 Objective To investigate the efficacy and safety of multitarget therapy with steroid, mycophenolate mofetil (MMF) and tacrolimus (FK506) in the treatment of refractory glomerular diseases. Methods Fifteen patients with lupus nephritis (LN), 3 patients with membranoproliferative glomerulonephritis (MPGN) and 3 patients with membranous nephropathy (MN) who failed the previous immunosuppressive therapy from May 2008 to March 2010 in our hospital were treated with multitarget therapy. The initial dose of prednisone was 30-40 mg/d and then tapered gradually. MMF and FK506 were started at 0.5 g/d or 1 mg/d, and the target blood concentration of the two drugs was 20-40 mg/(h·L) and 5-8 ng/mL respectively. Clinical parameters such as liver and renal function, urine protein, and side effects were recorded and analyzed in the regular follow-up. Results After 6 months of treatment, 7 (46.7%) of the 15 LN patients achieved complete remission (CR), 5 (33.3%) achieved partial remission (PR), while 3 (20%) failed this treatment and had no response (NR). All of the three MPGN patents had NR to this combined therapy. Two (66.7%) of the 3 MN patents achieved PR while 1 (33.3%) had NR. No patient withdrew or died because of side effects. One patient developed upper respiratory infection, one experienced alopecia, two developed gastrointestinal syndrome and three experienced gradual increasing in the serum creatinine. Conclusion Multitarget therapy with FK506, MMF and steroid is an effective and safe therapy for refractory lupus nephritis and it can be used in patients who are resistant to the conventional immunosuppressive therapy. However, this combined therapy does not meet a satisfactory result in patients with MN and MPGN, which entails further study.